Risk of catheter-related emboli in patients with atherosclerotic debris in the thoracic aorta

Silent and Apparent Cerebral Ischemia After Percutaneous Transfemoral Aortic Valve Implantation

“…34 The risk of cerebral embolism is associated with the complexity of aortic atheroma and may be increased during invasive cardiovascular procedures when aortic plaques are scraped by catheters with subsequent embolization of debris to the brain. 35,36 It has been shown that scraping of aortic plaques occurs in Ͼ50% of percutaneous cardiac interventions and is more frequent with large than with small catheters. 36,37 Therefore, dislodgement of debris from ascending or arch atheroma during passage of the large-bore valve delivery catheters has the potential to add substantially to the high risk of cerebral embolization.…”

Periprocedural Stroke and Cardiac Catheterization

“…16 The risk of cerebral embolism and peripheral embolism is associated with this atheroma burden, especially during invasive procedures. 17 Given these anatomic considerations in atheroma distribution, the choice of arterial access site may have some relevance in the determination of embolic risk, as previously suggested, 17,18 with the potential advantage of an upper-limb approach in high-risk patients. Therefore, particularly in patients with several risk factors (eg, older age, previous stroke, diabetes mellitus, and hypertension) or during emergency procedures, prevention of ischemic stroke requires a meticulous technique including adequate anticoagulation, frequent catheter flushing with heparinized saline, and over-the-wire exchange catheters.…”

Aortic Atherosclerotic Disease and Stroke

“…76 Most patients with embolic complication after catheterization have severe plaque on TEE. 77 One mechanism that has been suggested for causing these complications is the scraping of atherosclerotic debris by coronary guiding catheters. 78 In 1 study that evaluated this mechanism, debris was collected in the backflow from catheters in 50% of catheterizations involving patients with atherosclerotic coronary artery disease.…”