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Carraro do Nascimento V, de Villiers L, Dhillon PS, Domitrovic L, Sesnan G, Leblanc JP, Ninnes L, Hughes I, Rice H. Transradial versus transfemoral access for diagnostic cerebral angiography: frequency of acute MRI findings in 500 consecutive patients at a single center. J Neurointerv Surg 2024:jnis-2024-021472. [PMID: 38503510 DOI: 10.1136/jnis-2024-021472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The frequency of clinically symptomatic and asymptomatic diffusion-weighted imaging (DWI) hyperintense lesions and their correlation with the transradial artery (TRA) approach is unclear. OBJECTIVE To assess the frequency of abnormal diffusion restriction foci on DWI following cerebral angiography (digital subtraction angiography (DSA)) with the TRA or transfemoral artery (TFA) approach and identify predictors of DWI restriction foci. METHODS We analysed data from consecutive diagnostic cerebral angiograms obtained between January 2021 and October 2023 at a single tertiary center. MRI DWI was performed 2 hours after DSA. Patients underwent neurological assessment periprocedurally, as well as prior to discharge. RESULTS 500 patients were analysed; 277 (55%) procedures were performed via TRA and 223 (45%) via TFA. Overall, 74 (14.8%) patients had abnormal findings in the postprocedure MRI DWI. A higher incidence of positive DWI findings was noted in the TRA group, with 46 (16.6%) patients, compared with 28 (12.6%) in the TFA group (P=0.21). Symptomatic events occurred in seven (2.5%) of the TRA group and in two (0.9%) of the TFA cohort (P=0.31). At 60 days, the neurological deficit rate was one (0.4%) for the TRA group and one (0.4%) for the TFA group. Procedure time was the only significant predictor of DWI restriction (OR=1.04 per minute; P=0.0001). CONCLUSION Although there were more symptomatic or asymptomatic embolic events with TRA than with the TFA approach following elective cerebral angiography, this was not significantly different. We recommend the choice of vascular access based on patient anatomy and characteristics, aimed at improving care through enhanced safety.
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Affiliation(s)
| | - Laetitia de Villiers
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Permesh Singh Dhillon
- Department of Interventional Neuroradiology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Luis Domitrovic
- Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Genevieve Sesnan
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Jean-Philippe Leblanc
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Louise Ninnes
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hal Rice
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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2
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Yamaji K, Iwanaga Y, Kakehi K, Fujita K, Kawamura T, Hirase C, Ueno M, Nakazawa G. Prognostic Significance of Asymptomatic Cerebral Infarction in Patients After Cardiac Catheterization. Int Heart J 2024; 65:13-20. [PMID: 38296566 DOI: 10.1536/ihj.23-382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Recent studies have showed that asymptomatic cerebral infarction (ACI) developed in a reasonable number of patients after cardiac catheterization. However, no study has investigated the long-term prognostic impact of ACI after cardiac catheterization. We investigated whether ACI after cardiac catheterization affects long-term mortality and subsequent cardiovascular events.We retrospectively enrolled patients who underwent cardiac catheterization before cardiac surgery and cerebral diffusion-weighted magnetic resonance imaging (DWI). The incidence and clinical features of ACI were investigated. The long-term prognosis, including all-cause mortality and subsequent major cardiovascular events (MACE; all-cause mortality, stroke, acute myocardial infarction, fatal arrhythmia, and hospitalized heart failure), was also assessed.A total of 203 patients were enrolled. Of these, 10.3% had ACI diagnosed by DWI. There were no differences in baseline characteristics between patients with and without ACI, except more frequent history of symptomatic stroke in patients with ACI. In the Kaplan-Meier analysis during a median follow-up of 1009 days, the patients with ACI showed worse mortality and a slightly higher occurrence of MACE compared with those without ACI (P = 0.01 and P = 0.08, respectively). In addition, ACI was a prognostic marker independent of age, surgery type, and history of stroke.ACI after cardiac catheterization frequently developed and was also associated with long-term prognosis. It may be an independent prognostic marker in high-risk patients who underwent subsequent cardiac surgery.
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Affiliation(s)
- Kenji Yamaji
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
- Division of Cardiology, Pref Osaka Saiseikai Izuo Hospital
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
- Department of Cardiology, Sakurabashi-Watanabe Hospital
| | - Kazuyoshi Kakehi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | - Kosuke Fujita
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | - Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | | | - Masafumi Ueno
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
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3
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Brito J, Raposo L, Teles RC. Invasive assessment of aortic stenosis in contemporary practice. Front Cardiovasc Med 2022; 9:1007139. [PMID: 36531706 PMCID: PMC9751012 DOI: 10.3389/fcvm.2022.1007139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/08/2022] [Indexed: 11/20/2023] Open
Abstract
The authors review the current role of cardiac catheterization in the characterization of aortic stenosis, its main clinical applications, its pitfalls, and its additional value to the information provided by echocardiography. Discrepancies that may arise between these two modalities are discussed and further explained. Hemodynamic variables besides transvalvular pressure drop are described, and emphasis is given to an integrative approach to aortic stenosis assessment, that includes invasive and noninvasive evaluation.
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Affiliation(s)
- João Brito
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Interventional Cardiology Center, Hospital da Luz, Lisbon, Portugal
| | - Luís Raposo
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Interventional Cardiology Center, Hospital da Luz, Lisbon, Portugal
| | - Rui Campante Teles
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Interventional Cardiology Center, Hospital da Luz, Lisbon, Portugal
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4
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Wu R, Peters GL, Charles H, Kokabi N, Bercu ZL, Majdalany BS. Transradial Uterine Artery Embolization Complicated by Stroke. Semin Intervent Radiol 2022; 39:591-595. [PMID: 36561802 PMCID: PMC9767778 DOI: 10.1055/s-0042-1759700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Richard Wu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Gail L. Peters
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Hearns Charles
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Zachary L. Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Bill S. Majdalany
- Department of Radiology, The University of Vermont Medical Center, Burlington, Vermont
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5
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Shaban S, Huasen B, Haridas A, Killingsworth M, Worthington J, Jabbour P, Bhaskar SMM. Digital subtraction angiography in cerebrovascular disease: current practice and perspectives on diagnosis, acute treatment and prognosis. Acta Neurol Belg 2022; 122:763-780. [PMID: 34553337 DOI: 10.1007/s13760-021-01805-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
Digital Subtraction Angiography (DSA) is the gold-standard imaging modality in acute cerebrovascular diagnosis. The role of DSA has become increasingly prominent since the incorporation of endovascular therapy in standards of care for acute ischemic stroke. It is used in the assessment of cerebral vessel patency; however, the therapeutic role of DSA from a prognostic standpoint merits further investigation. The current paper provides an update on current practice on diagnostic, therapeutic and prognostic use of DSA in acute cerebrovascular diseases and various indications and perspectives that may apply, or limit its use, in ongoing surveillance or prognosis. Pre-clinical and clinical studies on the aspects, including but not limited to the morphology of cerebrovasculature in acute ischaemic stroke, are required to delineate and inform its prognostic role.
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Affiliation(s)
- Shirin Shaban
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
| | - Bella Huasen
- Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Abilash Haridas
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- Baycare Medical Group, Pediatric Neurosurgery, Cerebrovascular and Skull Base Neurosurgery, St Joseph's Hospital, Tampa, FL, USA
| | - Murray Killingsworth
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia
- Department of Anatomical Pathology, Correlative Microscopy Facility, NSW Health Pathology, Sydney, Australia
| | - John Worthington
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- RPA Comprehensive Stroke Service and Department of Neurology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia.
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia.
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia.
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, Australia.
- Department of Neurology and Neurophysiology, Clinical Sciences Building, Liverpool Hospital, Elizabeth St, Liverpool, NSW, 2170, Australia.
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6
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Soulaidopoulos S, Michalakeas C, Angelidakis P, Kolovos G, Kiourkou A, Tsioufis K, Vlachopoulos C. Coronary Arteriography Complicated with Ophthalmoplegia. Am J Med Sci 2021; 363:84-85. [PMID: 34672997 DOI: 10.1016/j.amjms.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/15/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Stergios Soulaidopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christos Michalakeas
- Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Anna Kiourkou
- Department of Neurology, Evangelismos Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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7
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Kussman BD, Imaduddin SM, Gharedaghi MH, Heldt T, LaRovere K. Cerebral Emboli Monitoring Using Transcranial Doppler Ultrasonography in Adults and Children: A Review of the Current Technology and Clinical Applications in the Perioperative and Intensive Care Setting. Anesth Analg 2021; 133:379-392. [PMID: 33764341 DOI: 10.1213/ane.0000000000005417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcranial Doppler (TCD) ultrasonography is the only noninvasive bedside technology for the detection and monitoring of cerebral embolism. TCD may identify patients at risk of acute and chronic neurologic injury from gaseous or solid emboli. Importantly, a window of opportunity for intervention-to eliminate the source of the emboli and thereby prevent subsequent development of a clinical or subclinical stroke-may be identified using TCD. In this review, we discuss the application of TCD sonography in the perioperative and intensive care setting in adults and children known to be at increased risk of cerebral embolism. The major challenge for evaluation of emboli, especially in children, is the need to establish the ground truth and define true emboli identified by TCD. This requires the development and validation of a predictive TCD emboli monitoring technique so that appropriately designed clinical studies intended to identify specific modifiable factors and develop potential strategies to reduce pathologic cerebral embolic burden can be performed.
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Affiliation(s)
- Barry D Kussman
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Syed M Imaduddin
- Department of Electrical Engineering and Computer Science, the Institute for Medical Engineering and Science, and the Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Mohammad Hadi Gharedaghi
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Thomas Heldt
- Department of Electrical Engineering and Computer Science, the Institute for Medical Engineering and Science, and the Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kerri LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.,Department of Neurology, Harvard Medical School, Boston, Massachusetts
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8
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Echocardiographic parameters determining cardiovascular outcomes in patients after acute ischemic stroke. Int J Cardiovasc Imaging 2020; 36:1445-1454. [PMID: 32297100 DOI: 10.1007/s10554-020-01841-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022]
Abstract
Previous studies have focused on only 1 or 2 echocardiographic parameters as prognostic markers in patients with acute ischemic stroke (AIS). A total of 900 patients with AIS who underwent transthoracic echocardiography (72.6 ± 12.0 years and 60% males) were retrospectively reviewed. Composite clinical events, including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization, were assessed during clinical follow-ups. During a median follow-up of 3.3 years (interquartile range 0.6-5.1 years), there were 151 (16.8%) composite events. In the multivariable analyses after controlling for potential confounders, left ventricular ejection fraction (LVEF) < 62% (hazard ratio [HR] 1.62; 95% confidence interval [CI] 1.14-2.30; p = 0.007) and AV sclerosis (AVs) (HR 1.56; 95% CI 1.10-2.21; p = 0.013) were independent prognostic factors associated with composite events. Multivariable analyses showed that HR for composite events gradually increased according to LVEF and AVs: HR was 2.6-fold higher in the highest-risk group than in the lowest group (p < 0.001). Compared with a clinical model (global chi-square = 69.6), LVEF, AVs, and both of them were significantly improved outcome prediction in sequential Cox model analysis (global chi-square = 75.6, 75.7, and 78.8, respectively; p < 0.05 for each) for each. In patients with AIS, LVEF < 62%, and the presence of AV sclerosis can predict future vascular events. Patients with AIS exhibiting reduced LVEF and AV sclerosis may benefit from aggressive secondary prevention.
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9
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Jilani MH, Iqbal H, Huda S, Khan AY, Charlamb L. Double Vision: Isolated Third Cranial Nerve Palsy After Cardiac Catheterization. Cureus 2020; 12:e9202. [PMID: 32685329 PMCID: PMC7366043 DOI: 10.7759/cureus.9202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/15/2020] [Indexed: 11/05/2022] Open
Abstract
Neurological complications after cardiac catheterization are rare. We report an unusual case of isolated third cranial nerve palsy in a 72-year-old male patient whose past medical history was significant for diabetes mellitus and coronary artery disease (CAD). He presented for elective cardiac catheterization for stable angina, which revealed multivessel CAD and no intervention was done. Two hours after the procedure, the patient suddenly started complaining of new-onset double vision in his left eye. Ophthalmologic exam revealed ptosis of the left eye lid, sluggish pupillary reflex and impaired adduction of the left eye along with exotropia of the left eye on primary gaze, all findings consistent with the left third nerve palsy. Rest of the neurological exam and neuroimaging (CT angiogram of head and MRI brain) were normal. Embolic phenomenon has been described as a possible mechanism in such patients leading to small vessel ischemic disease and cerebral microinfarction. Neuro-ophthalmologic complications after cardiac catheterization are rare but devastating for the patients. These should be recognized promptly, and patients should undergo neuroimaging to evaluate for any identifiable causes. These patients should be treated with aspirin and statin therapy and evaluated by ophthalmology for correction with prism lenses if symptoms persist.
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Affiliation(s)
- Mohammad H Jilani
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Hameed Iqbal
- Medicine, Guthrie Cortland Medical Center, Cortland, USA
| | - Syed Huda
- Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | | | - Larry Charlamb
- Cardiology, State University of New York Upstate University Hospital, Syracuse, USA
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10
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Marchese N, Copetti M, Inchingolo V, Popolizio T, Fontana A, Simeone A, Vigna C. Cerebral Infarcts After Coronary Angiography and Percutaneous Coronary Intervention: A Prospective Propensity-Score-Adjusted Comparison of Right Radial, Left Radial, and Femoral Approaches. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:882-887. [PMID: 31761638 DOI: 10.1016/j.carrev.2019.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND New cerebral infarcts (CIs) detected at magnetic resonance imaging (MRI) are reported after cardiac procedures. Clinical and procedural aspects are implicated as potential causal factors. The aim of this study was to evaluate the incidence of new CIs after coronary angiography and percutaneous coronary intervention according to the arterial access site. METHODS 180 patients undergoing elective coronary angiography were studied with cerebral MRI the day before and the day after the procedure. Unadjusted and propensity score (PS) analyses were performed comparing the occurrence of CIs in right radial (RR), left radial (LR) and transfemoral (TF) access groups. RESULTS New CIs were observed in 14 patients (7.8% of the total sample, one with neurological sequelae). CIs were detected in 15.5% vs 4.9% vs 3.3% of RR, LR and TF groups, respectively (p = .026). In PS adjusted analyses, the RR approach was associated with more CIs compared with the TF approach (odds ratio [OR] estimate from logistic regression adjusted by PS quartiles: 0.158; 95% confidence interval: 0.031 to 0.814; p = .027) and the LR approach (OR: 0.266; 95% confidence interval: 0.066 to 1.080; p = .064). In a secondary analysis, a comparison of RR vs non-RR approach (TF + LR) was performed, showing that post-procedural CIs were more frequent in the RR group (OR: 0.170; 95% confidence interval: 0.050 to 0.574; p = .004). CONCLUSIONS Our study suggests that the RR approach may be associated with a higher rate of new CIs after coronary angiography compared with LR and TF approaches.
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Affiliation(s)
- Nicola Marchese
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Vincenzo Inchingolo
- Unit of Neurology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Teresa Popolizio
- Unit of Radiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Annalisa Simeone
- Unit of Neurology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carlo Vigna
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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11
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Michaud GF. Asymptomatic Cerebral Emboli With the PVAC Gold: Worth Another Look? JACC Clin Electrophysiol 2019; 5:327-329. [PMID: 30898235 DOI: 10.1016/j.jacep.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Gregory F Michaud
- Vanderbilt University Medical Center, Cardiovascular Division, Nashville, Tennessee.
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12
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Göksülük H, Güleç S, Özyüncü N, Kürklü ST, Vurgun VK, Candemir B, Uludağ MG, Öztürk S, Us E, Erol Ç. Comparison of Frequency of Silent Cerebral Infarction After Coronary Angiography and Stenting With Transradial Versus Transfemoral Approaches. Am J Cardiol 2018; 122:548-553. [PMID: 29960662 DOI: 10.1016/j.amjcard.2018.04.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
Silent cerebral infarction (SCI) can be seen after coronary procedures. We investigated whether vascular access sites have an impact on the risk of SCI. A total of 255 consecutive patients who underwent diagnostic or interventional coronary procedures through transfemoral (n = 126 patients) or transradial (n = 129 patients) approach were evaluated. Neuron-specific enolase (NSE) levels were studied before and 12 hours after the procedure. Elevation of greater than 12 ng/ml was considered as SCI. Patients were mainly men (60%) with a mean age of 62 years. SCI was observed in 74 of 255 patients (29%). It was significantly more prevalent among transradial group. Elevation of NSE was observed in 36% of transradial group (n = 47) and 21% of the transfemoral group (n = 27) (p = 0.008). Patients with SCI were more likely to have male sexuality, hyperlipidemia, history of smoking, and previous myocardial infarction. Multivariate analysis demonstrated that patients who underwent coronary procedures through transradial approach were 2.1 times more likely to have an SCI than patients with transfemoral approach (95% confidence interval [CI] 1.205 to 3.666; p = 0.008). Other independent predictors of NSE elevation were previous myocardial infarction (odds ratio 8.6; 95% CI 4.209 to 17.572; p <0.001) and smoking history (odds ratio 7.251; 95% CI 3.855 to 13.639; p <0.001). The present study suggests that transradial coronary procedures carry higher risk of SCI when compared with transfemoral route.
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Affiliation(s)
- Hüseyin Göksülük
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey.
| | - Sadi Güleç
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey
| | - Nil Özyüncü
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey
| | - Seda Tan Kürklü
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey
| | - Veysel Kutay Vurgun
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey
| | - Başar Candemir
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey
| | | | - Semih Öztürk
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey
| | - Ebru Us
- Medical Microbiology Department, Ankara University, Ankara, Turkey
| | - Çetin Erol
- Cardiology Department, Ankara University, İbni Sina Hospital, Ankara, Turkey
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13
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Fanari Z, Gunasekaran PC, Shaukat A, Hammami S, Dawn B, Wiley M, Tadros P. Safety and utility of dobutamine and pressure wire use in the hemodynamic assessment of low-flow, low-gradient aortic stenosis with reduced left ventricular ejection fraction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:438-443. [DOI: 10.1016/j.carrev.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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14
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Salem SA, Haji S, Garg N, Khouzam RN, Jagadish P, Alsafwah S. Occlusion of right coronary artery by microembolization caused by excessive diagnostic catheter manipulation. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:20. [PMID: 29404366 DOI: 10.21037/atm.2017.12.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With advancing technology and newer therapeutic and diagnostic techniques, physicians are now encountering new complications or increasing frequency of known complications than before. left cardiac catheterization and coronary angiography is not an exception. As transradial cardiac catheterization is now becoming more popular, operators should be more aware of related challenges and limitations associated. Tortuous right bracheocephalic artery is an anatomical variance that makes radial catheterization more difficult, and may indeed add additional time and risk to the procedure and patient, respectively. Hence, we present this case report.
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Affiliation(s)
- Salem A Salem
- Department of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Showkat Haji
- Department of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nadish Garg
- Department of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Department of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pooja Jagadish
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shadwan Alsafwah
- Department of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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Hashizume N, Miura T, Miyashita Y, Motoki H, Ebisawa S, Izawa A, Koyama J, Ikeda U, Kuwahara K. Prognostic Value of Ankle-Brachial Index in Patients Undergoing Percutaneous Coronary Intervention: In-Hospital and 1-Year Outcomes From the SHINANO Registry. Angiology 2017; 68:884-892. [PMID: 28956475 DOI: 10.1177/0003319717697883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concomitant coronary and peripheral artery disease is associated with higher periprocedural and long-term percutaneous coronary intervention (PCI) complication rates. We evaluated in-hospital and 1-year clinical outcomes of patients with low or borderline ankle-brachial indexes (ABIs) undergoing PCIs in the drug-eluting stent era. We divided 1370 SHINANO registry patients into 3 groups-low (ABI ≤ 0.9), borderline (0.9 < ABI ≤ 1.0), and normal (1.0 ≤ ABI < 1.4). During the 1-year follow-up, more PCI-related complications occurred in the low and borderline ABI groups than in the normal ABI group (7.7% vs 8.8% vs 4.0%, respectively). Low ABI patients were more likely to experience adverse clinical events (6.3% vs 3.6% vs 3.0%, respectively; log-rank P = .020 for low vs normal ABI), with a hazard ratio of 2.27 (95% confidence interval, 1.12-4.61; P = .023), compared with patients with normal ABIs. Patients with abnormal ABIs had a significantly higher incidence of PCI-related complications and a less favorable 1-year prognosis. Routine ABI measurement before PCI may help predict PCI-related complication incidence and 1-year prognosis.
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Affiliation(s)
- Naoto Hashizume
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Miura
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyashita
- 2 Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hirohiko Motoki
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Izawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Koyama
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Uichi Ikeda
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koichiro Kuwahara
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Sirker A, Kwok CS, Kotronias R, Bagur R, Bertrand O, Butler R, Berry C, Nolan J, Oldroyd K, Mamas MA. Influence of access site choice for cardiac catheterization on risk of adverse neurological events: A systematic review and meta-analysis. Am Heart J 2016; 181:107-119. [PMID: 27823682 DOI: 10.1016/j.ahj.2016.06.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/25/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stroke is a rare but potentially catastrophic complication of cardiac catheterization. Although some procedural aspects are known to influence stroke risk, the impact of radial versus femoral access site use is unclear. Early observational studies and limited randomized trial data suggested more frequent embolic events with radial access. Subsequently, larger pooled analyses have shown no clear differences in stroke risk but were limited by low event rates. Recent publication of relevant new data prompted our reevaluation of this concern. Therefore, we conducted a systematic review and meta-analysis to evaluate stroke complicating cardiac catheterization with use of transradial versus transfemoral access. METHODS AND RESULTS A search of MEDLINE and EMBASE was undertaken using OVID SP with appropriate search terms. RevMan 5.3.5 was used to conduct a random-effects meta-analysis using the inverse variance method for pooling risk ratios (RRs) or the Mantel-Haenszel method for pooling dichotomous data. Pooled data from >24,000 patients in randomized controlled trials and >475,000 patients from observational studies were used. The risk ratio (RR) for (any) stroke, using randomized controlled trial data, was not significant (RR 0.87, 95% CI 0.58-1.29). Using observational data, a significant difference favoring radial access was seen (RR 0.71, 95% CI 0.52-0.98). CONCLUSIONS Radial access site utilization for cardiac catheterization is not associated with an increased risk of stroke events. These data provide reassurance and should remove another potential barrier to conversion to a "default" radial practice among those who are currently predominantly femoral operators.
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Affiliation(s)
- Alex Sirker
- Department of Cardiology, University College London Hospitals and St. Bartholomew's Hospital, London, United Kingdom
| | - Chun Shing Kwok
- Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Rafail Kotronias
- Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- Division of Cardiology, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Olivier Bertrand
- Quebec Heart-Lung Institute, Laval University, Laval, Quebec, Canada
| | - Robert Butler
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - James Nolan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Keith Oldroyd
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Mamas A Mamas
- Department of Cardiology, University College London Hospitals and St. Bartholomew's Hospital, London, United Kingdom; Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom.
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Wallace S, Døhlen G, Holmstrøm H, Lund C, Russell D. Cerebral Microemboli Detection and Differentiation During Transcatheter Closure of Patent Ductus Arteriosus. Pediatr Cardiol 2016; 37:1141-7. [PMID: 27229332 DOI: 10.1007/s00246-016-1410-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
The aim of this prospective study was to determine the frequency and composition of cerebral microemboli in a pediatric population, during transcatheter closure of patent ductus arteriosus (PDA). Multifrequency transcranial Doppler was used to monitor cerebral blood flow velocity (CBFV) and detect microembolic signals (MES) in the middle cerebral artery in 23 patients (median age 18 months). MES were automatically identified and differentiated according to composition; gaseous or solid. The procedure was divided into five periods: Arterial catheterization; venous catheterization; ductal catheterization; angiography; device placement and release. Timing of catheter manipulations and MES were registered and compared. MES were detected in all patients. The median number of signals was 7, (minimum 1, maximum 28). Over 95 % of all MES were gaseous. 11 % were detected during device placement while 64 % were detected during angiographic studies, significantly higher than during any other period (P < 0.001). There was a moderate correlation between the number of MES and volume of contrast used, (R = 0.622, P < 0.01). There was no correlation with fluoroscopic time or duration of procedure. This is the first study to investigate the timing and composition of cerebral microemboli during PDA occlusion. Microemboli were related to specific catheter manipulations and correlated with the amount of contrast used.
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Affiliation(s)
- Sean Wallace
- Department of Paediatric Cardiology, Rikshospitalet, Oslo, Norway.
| | - Gaute Døhlen
- Department of Paediatric Cardiology, Rikshospitalet, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Paediatric Cardiology, Rikshospitalet, Oslo, Norway
| | | | - David Russell
- Department of Neurology, Rikshospitalet, Oslo, Norway
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Kreutzinger P, Wildi K, Twerenbold R, Rubini Gimenez M, Reichlin T, Jaeger C, Hillinger P, Boeddinghaus J, Nestelberger T, Puelacher C, Stallone F, Rentsch K, Osswald S, Jeger R, Kaiser C, Mueller C. Incidence and Predictors of Cardiomyocyte Injury in Elective Coronary Angiography. Am J Med 2016; 129:537.e1-8. [PMID: 26763753 DOI: 10.1016/j.amjmed.2015.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Coronary angiography is considered to be a safe tool for the evaluation of coronary artery disease and performed in approximately 12 million patients each year worldwide. The aim of our study was to investigate the frequency and predictors of cardiomyocyte injury in patients undergoing elective coronary angiography. METHODS A total of 749 consecutive patients who were scheduled to undergo elective coronary angiography were prospectively analyzed. High-sensitivity cardiac troponin T concentrations were measured both before and after elective coronary angiography (without intervention). Acute cardiomyocyte injury was predefined as an absolute increase in high-sensitivity cardiac troponin T of at least 7 ng/L (if also fulfilling a relative change of >20%). RESULTS Acute cardiomyocyte injury was observed in 101 patients (13.5%, 95% confidence interval [CI], 11.1-16.2). It was independently associated with aortic valve stenosis (odds ratio [OR], 5.4; 95% CI, 3.0-9.8; P <.001), age (OR, 1.05; 95% CI, 1.02-1.08; P <.001), female sex (OR, 3.5; 95% CI, 1.8-6.8; P <.001), contrast volume (OR, 1.006; 95% CI, 1.001-1.012; P = .019 per 10 mL of contrast volume), documented cardiomyopathy (OR, 2.5; 95% CI, 1.0-6.0; P = .045), and mitral regurgitation (OR, 2.3; CI, 1.0-4.9; P = .033). In contrast, operator experience and extent of coronary artery disease were not found to be associated with acute cardiomyocyte injury. CONCLUSIONS Cardiomyocyte injury accompanies elective coronary angiography in 1 of 8 patients. Sex, age, contrast agent volume, and ventricular disease, rather than the extent of coronary artery disease, independently predict cardiomyocyte injury. Further research aiming to reduce the incidence of cardiomyocyte injury seems warranted.
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Affiliation(s)
- Philipp Kreutzinger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Cedric Jaeger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Petra Hillinger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Fabio Stallone
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Switzerland
| | | | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Raban Jeger
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
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Incidence and Predictors of Catheterization-Related Cerebral Infarction on Diffusion-Weighted Magnetic Resonance Imaging. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6052125. [PMID: 27127790 PMCID: PMC4835628 DOI: 10.1155/2016/6052125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
Introduction. The aim of this study was to examine the incidence and risk factors of catheterization-related CI in the contemporary era, using diffusion-weighted magnetic resonance imaging. Methods. We retrospectively analyzed consecutive 84 patients who underwent MRI (magnetic resonance imaging) after 2.81 ± 2.4 days (mean ± SD) of catheterization via aortic arch. We categorized the patients by the presence or absence of acute CI determined by diffusion-weighted MRI and analyzed the incidence and predictors. Results. Of 84 patients that underwent MRI after catheterization, acute CI was determined in 27 (32.1%) patients. In univariate analysis, dyslipidemia, age, coronary artery disease, antiplatelet agents, number of catheters used, urgent settings, and interventional procedures were significantly different. Multivariate analysis revealed dyslipidemia (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.41–16.03; p = 0.01), higher age (OR, 1.09; 95% CI, 1.007–1.19; p = 0.03), and the number of catheters used (OR, 2.21; 95% CI, 1.21–4.36; p = 0.01) as independent predictors of the incidence of catheterization-related acute CI. Conclusions. Dyslipidemia, higher age, and number of catheters used were independent predictors for acute CI after catheterization. These findings imply that managing dyslipidemia and comprehensive planning to minimize the numbers of catheters are important.
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20
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Yang CS, Marshall ES, Fanari Z, Kostal MJ, West JT, Kolm P, Weintraub WS, Doorey AJ. Discrepancies between direct catheter and echocardiography-based values in aortic stenosis. Catheter Cardiovasc Interv 2016; 87:488-97. [PMID: 26033475 PMCID: PMC4663183 DOI: 10.1002/ccd.26033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 04/10/2015] [Accepted: 04/29/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The goal of this article is to examine the correlation of catheter (cath) based and echocardiographic assessment of aortic stenosis (AS) in a community-based academic hospital setting, particularly in the degree that decision to refer for surgery is altered. BACKGROUND Current guidelines discourage AS evaluation by invasive pressure measurement if echocardiography (echo) is adequate, but several studies show sizable differences between echo and cardiac catheterization lab (CCL) measurements. We examine this correlation using high quality CCL techniques. METHODS Sequential patients with suspected AS by echo (n = 40) aged 61-94 underwent catheterization with pressure gradients via left ventricular pressure wire and ascending aorta catheter. The echos leading to the catheterization were independently reviewed by an expert panel to assess the quality of community-based readings. RESULTS CCL changed assessment of severity of aortic valve area (AVA) by more than 0.3 cm(2) in 25% and 0.5 cm(2) in 8%. Values changed to over or under the surgical threshold of AVA < 1 cm(2) in 30% of the patients. Pearson correlation of 0.35 between measurements of AVA by echo and CCL is lower than earlier studies, which often reported correlation values of 0.90 or greater. Echo expert reviews provided minimal improvement in discrepancies (Pearson correlation of 0.46), suggesting quality of initial interpretation was not the issue. CONCLUSIONS Cath-echo correlation of AS severity is lower in contemporaneous practice than previously assumed. This can alter the decision for aortic valve replacement. Sole reliance on echo-derived assessment of AS may at times be problematic.
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Affiliation(s)
- Chia-Shing Yang
- Department of Medicine, Christiana Care Health System, Newark, DE
| | - Erik S. Marshall
- Section of Cardiology, Christiana Care Health System, Newark, DE
| | - Zaher Fanari
- Section of Cardiology, Christiana Care Health System, Newark, DE
| | | | - Joseph T. West
- Section of Cardiology, Christiana Care Health System, Newark, DE
| | - Paul Kolm
- Value Institute, Christiana Care Health System, Newark, DE
| | - William S. Weintraub
- Section of Cardiology, Christiana Care Health System, Newark, DE
- Value Institute, Christiana Care Health System, Newark, DE
| | - Andrew J. Doorey
- Section of Cardiology, Christiana Care Health System, Newark, DE
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Butman S. Cerebroradial issue: Not so much. Catheter Cardiovasc Interv 2015; 86:71-2. [PMID: 26011781 DOI: 10.1002/ccd.26049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/07/2022]
Abstract
Cerebral events are quite uncommon around the time of any cardiac catheterization procedure. No significant difference seen in cerebral events between radial and femoral approaches was evident in this large prospective registry. Still hard to find a reason not go radial. Go radial.
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22
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Raposo L, Madeira S, Teles RC, Santos M, Gabriel HM, Gonçalves P, Brito J, Leal S, Almeida M, Mendes M. Neurologic complications after transradial or transfemoral approach for diagnostic and interventional cardiac catheterization: A propensity score analysis of 16,710 cases from a single centre prospective registry. Catheter Cardiovasc Interv 2015; 86:61-70. [DOI: 10.1002/ccd.25884] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/31/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Luis Raposo
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Sérgio Madeira
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Rui Campante Teles
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Miguel Santos
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Henrique Mesquita Gabriel
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Pedro Gonçalves
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - João Brito
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Silvio Leal
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Manuel Almeida
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
| | - Miguel Mendes
- Cardiology Department - UNICARV; Hospital De Santa Cruz, Centro Hospitalar De Lisboa Ocidental; Lisbon Portugal
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Sim HT, Kim SR, Beom MS, Chang JW, Kim NR, Jang MH, Ryu SW. Neurologic outcomes of preoperative acute silent cerebral infarction in patients with cardiac surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 47:510-6. [PMID: 25551071 PMCID: PMC4279829 DOI: 10.5090/kjtcs.2014.47.6.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/15/2014] [Accepted: 08/07/2014] [Indexed: 11/30/2022]
Abstract
Background Acute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI. Methods We retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was 68.8±9.5 years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies. Results There were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions. Conclusion Patients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.
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Affiliation(s)
- Hyung Tae Sim
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Sung Ryong Kim
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Min Sun Beom
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Ji Wook Chang
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Na Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Mi Hee Jang
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Sang Wan Ryu
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
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Duffis EJ, Jones D, Tighe D, Moonis M. Neurological complications of coronary angiographic procedures. Expert Rev Cardiovasc Ther 2014; 5:1113-21. [DOI: 10.1586/14779072.5.6.1113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Werner N, Zahn R, Zeymer U. Stroke in patients undergoing coronary angiography and percutaneous coronary intervention: incidence, predictors, outcome and therapeutic options. Expert Rev Cardiovasc Ther 2014. [DOI: 10.1586/erc.12.78] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hassell MEC, Nijveldt R, Roos YBW, Majoie CBL, Hamon M, Piek JJ, Delewi R. Silent cerebral infarcts associated with cardiac disease and procedures. Nat Rev Cardiol 2013; 10:696-706. [PMID: 24165909 DOI: 10.1038/nrcardio.2013.162] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The occurrence of clinically silent cerebral infarcts (SCIs) in individuals affected by cardiac disease and after invasive cardiac procedures is frequently reported. Indeed, atrial fibrillation, left ventricular thrombus formation, cardiomyopathy, and patent foramen ovale have all been associated with SCIs. Furthermore, postprocedural SCIs have been observed after left cardiac catheterization, transcatheter aortic valve implantation, CABG surgery, pulmonary vein isolation, and closure of patent foramen ovale. Such SCIs are often described as precursors to symptomatic stroke and are associated with cognitive decline, dementia, and depression. Increased recognition of SCIs might advance our understanding of their relationship with heart disease and invasive cardiac procedures, facilitate further improvement of therapies or techniques aimed at preventing their occurrence and, therefore, decrease the risk of adverse neurological outcomes. In this Review, we provide an overview of the occurrence and clinical significance of, and the available diagnostic modalities for, SCIs related to cardiac disease and associated invasive cardiac procedures.
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Affiliation(s)
- Mariëlla E C Hassell
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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Pacchioni A, Versaci F, Mugnolo A, Penzo C, Nikas D, Saccà S, Favero L, Agostoni PF, Garami Z, Prati F, Reimers B. Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach. Int J Cardiol 2013; 167:3021-6. [DOI: 10.1016/j.ijcard.2012.09.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/19/2012] [Accepted: 09/12/2012] [Indexed: 11/25/2022]
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Werner N, Bauer T, Hochadel M, Zahn R, Weidinger F, Marco J, Hamm C, Gitt AK, Zeymer U. Incidence and Clinical Impact of Stroke Complicating Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2013; 6:362-9. [DOI: 10.1161/circinterventions.112.000170] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Stroke is a rare but serious complication of percutaneous coronary interventions (PCIs). So far, scant information is available about the incidence and outcome of patients developing stroke after PCI for stable angina or acute coronary syndrome (ACS) in daily clinical practice in Europe today.
Methods and Results—
Between 2005 and 2008, 46 888 patients undergoing PCI were enrolled into the PCI Registry of the Euro Heart Survey Programme (176 centers in 33 European countries) to document patient’s characteristics, PCI details, and hospital complications in different PCI indications. Stroke was observed in 0.4% of the procedures in the total population, in 0.3% of PCIs in elective patients, and in 0.6% in PCIs performed for ACS. The overall in-hospital mortality was 19.2% for patients who developed stroke (elective PCIs, 10.0%; PCI for ACS, 23.2%) compared with 1.3% for those without stroke (elective PCIs, 0.2%; PCI for ACS, 2.3%). In multivariate analysis hemodynamic instability, age ≥75 years, history of stroke, and congestive heart failure were found to be independent predictors for periprocedural stroke in ACS, whereas only PCI of a bypass graft and renal failure could be identified as independent predictors for stroke in elective patients.
Conclusions—
Stroke as complication of PCI occurs rarely (0.4%) in clinical practice in Europe today. However, peri-interventional stroke is still associated with an exceedingly high in-hospital mortality rate. Most predictors for periprocedural stroke are not modifiable and cannot be diminished before PCI. Therefore, treatment of patients with stroke after PCI needs further research.
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Affiliation(s)
- Nicolas Werner
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Timm Bauer
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Matthias Hochadel
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Ralf Zahn
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Franz Weidinger
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Jean Marco
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Christian Hamm
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Anselm K. Gitt
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Uwe Zeymer
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
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Popovic B, Carillo S, Agrinier N, Christophe C, Selton-Suty C, Juillière Y, Aliot E. Ischemic stroke associated with left cardiac catheterization: the importance of modifiable and non-modifiable risk factors. Am Heart J 2013; 165:421-6. [PMID: 23453113 DOI: 10.1016/j.ahj.2012.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stroke associated with left cardiac catheterization is a devastating complication, and its incidence has not changed over the decades. We investigated the incidence, in-hospital outcomes and the modifiable and non-modifiable risk factors for periprocedural ischemic stroke. METHODS Our retrospective cohort study included all patients experiencing periprocedural ischemic stroke among the 24,500 patients who underwent left cardiac catheterization between January 2003 and October 2010. The case group was compared with a group of control patients randomly selected among those who underwent the procedure during this period. RESULTS Ischemic cerebrovascular events attested by brain imaging occurred in 37 patients (0.15% of procedures), transient ischemic attack occurred in 9 cases, and persistent neurological deficit occurred in 28 cases. Patients who developed strokes were more likely to be older and were more often female with a greater prevalence of comorbidities. Emergency and longer procedures were more frequent in patients in the case group who had more coronary complications. A multivariate analysis identified diabetes mellitus (adjusted odds ratio (OR) 4.2; 95% CI 1.8-9.9; P < .001), chronic renal dysfunction (OR 2.4; 95% CI 1.1-5.4; P < .001), known cerebrovascular disease (OR 5.1; 95% CI 2.3-11.5; P < .001), emergency procedure (OR 3.1; 95% CI 1.4-9.2; P < .01) and recent congestive heart failure (OR 6.1; 95% CI 2.9-13; P < .001) as independent predictors for stroke. The independent modifiable predictive factors were represented by left ventricular angiography (OR 7.5; 95% CI 2.7-21; P < .001), and low operator volume (OR 3.1; 95% CI 1.3-7.4; P < .01). CONCLUSION Limiting the performance of left cardiac catheterization to high volume operators and avoiding unnecessary left ventricular angiography may reduce periprocedural ischemic stroke.
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Hamon M, Lipiecki J, Carrié D, Burzotta F, Durel N, Coutance G, Boudou N, Colosimo C, Trani C, Dumonteil N, Morello R, Viader F, Claise B, Hamon M. Silent cerebral infarcts after cardiac catheterization: a randomized comparison of radial and femoral approaches. Am Heart J 2012; 164:449-454.e1. [PMID: 23067900 DOI: 10.1016/j.ahj.2012.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 04/10/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Single center studies using serial cerebral diffusion-weighted magnetic resonance imaging in patients having cardiac catheterization have suggested that cerebral microembolism might be responsible for silent cerebral infarct (SCI) as high as 15% to 22%. We evaluated in a multicenter trial the incidence of SCIs after cardiac catheterization and whether or not the choice of the arterial access site might impact this phenomenon. METHODS AND RESULTS Patients were randomized to have cardiac catheterization either by Radial (n = 83) or Femoral (n = 77) arterial approaches by experimented operators. The main outcome measure was the occurrence of new cerebral infarct on serial diffusion-weighted magnetic resonance imaging. Patient and catheterization characteristics, including duration of catheterization, were similar in both groups. The risk of SCI did not differ significantly between the Femoral and Radial groups (incidence of 11.7% versus 17.5%; OR, 0.85; 95% CI, 0.62-1.16; P = .31). At multivariable analysis, the independent predictors of SCI were the patient's higher height and lower transvalvular gradient. CONCLUSIONS The high rate of SCI after cardiac catheterization of patients with aortic stenosis was confirmed, but its occurrence was not affected by the selection of Radial and Femoral access.
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Hynes BG, Rodés-Cabau J. Transcatheter aortic valve implantation and cerebrovascular events: the current state of the art. Ann N Y Acad Sci 2012; 1254:151-163. [PMID: 22548581 DOI: 10.1111/j.1749-6632.2012.06477.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the care of high-risk patients with severe calcific aortic stenosis. Those considered at high or prohibitive risk of major adverse outcomes with open surgical aortic valve replacement may now be offered an alternative less-invasive therapy. Despite the rapid evolution and clinical application of this new technology, recent studies have raised concerns about adverse cerebrovascular event rates in patients undergoing TAVI. In this review, we explore the current data both in relation to procedure-related silent cerebrovascular ischemic events, as well as clinically apparent stroke. The timing of neurological events and their prognostic implications are also examined. Finally, potential mechanisms of TAVI-related cerebrovascular injury are described, in addition to efforts to minimize their occurrence.
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Affiliation(s)
- Brian G Hynes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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Vázquez M, Santos E, Rodriguez I, Pato A, Vilar M, Arias JC, Fernández R, Costas I, Ghioldi A, Sanmartin M, Tardáguila F. Valoración mediante resonancia magnética cerebral de embolias clínicamente silentes en pacientes con fibrilación auricular sometidos a cardioversión eléctrica. Rev Esp Cardiol 2012; 65:139-42. [DOI: 10.1016/j.recesp.2011.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/17/2011] [Indexed: 11/16/2022]
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Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci 2012; 4:65-93. [PMID: 22980117 PMCID: PMC4777042 DOI: 10.5539/gjhs.v4n1p65] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 12/29/2011] [Indexed: 12/17/2022] Open
Abstract
Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading.
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Jazaeri O, Gupta R, Rochon PJ, Reece TB. Endovascular approaches and perioperative considerations in acute aortic dissection. Semin Cardiothorac Vasc Anesth 2011; 15:141-62. [PMID: 22194281 DOI: 10.1177/1089253211425424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic dissections remain complicated management issues both in the acute setting and in the chronic setting. Acute problems revolve around malperfusion syndromes or rupture, whereas chronic issues progress from the development of aneurysms in the residual dissected aorta. Endovascular approaches to dealing with these difficult situations are being used more frequently to treat acute issues in type B dissections and prevent secondary complications in type A dissections that may require significant intervention in the future. This article discusses the endovascular approaches employed in the care of acute dissections with particular attention toward the anesthetic considerations involved in these challenging cases.
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Affiliation(s)
- Omid Jazaeri
- University of Colorado Denver, Aurora, CO 80045, USA
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Schwarz N, Schoenburg M, Möllmann H, Kastaun S, Kaps M, Bachmann G, Sammer G, Hamm C, Walther T, Gerriets T. Cognitive decline and ischemic microlesions after coronary catheterization. A comparison to coronary artery bypass grafting. Am Heart J 2011; 162:756-63. [PMID: 21982670 DOI: 10.1016/j.ahj.2011.07.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 07/21/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postinterventional cognitive dysfunction (PICD) is a known complication of coronary artery bypass grafting (CABG). However, it is largely unknown whether PICD occurs after coronary catheterization. METHODS Neuropsychologic data were obtained from 37 patients who received coronary catheterization and 47 patients who underwent elective CABG at baseline and 3 months after the interventions. The outcomes were contrasted to 33 healthy volunteers, using analysis of covariance with baseline scores as covariates. Cerebral magnetic resonance imaging with diffusion-weighted imaging (DWI) sequences was performed in 30 catheter and 39 CABG patients 2 to 4 days after the procedures. RESULTS The rate of acute ischemic lesions amounted to 3.3% in the catheter group and to 17.9% in the CABG group. Postinterventional cognitive dysfunction was detected in 2 (of 10) tests in the catheter group as compared with the healthy controls (verbal memory: total recall, t = -2.61 (P = .005) and nonverbal memory, t = -2.60 [P = .005]). The CABG group showed PICD in 7 of 10 tests as compared with the healthy controls (statistics ranging from t = -1.95 [P = .027] to t = -5.14 [P < .001]). Scores of depression/anxiety and health-related quality of life were not associated with PICD (P > .05). CONCLUSIONS As compared with CABG, PICD and cerebral lesions appear to be substantially milder after coronary catheter intervention, but not negligible.
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Affiliation(s)
- Niko Schwarz
- Department of Neurology, Justus Liebig University Giessen, Germany
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Rodriguez CJ, Bartz TM, Longstreth WT, Kizer JR, Barasch E, Lloyd-Jones DM, Gottdiener JS. Association of annular calcification and aortic valve sclerosis with brain findings on magnetic resonance imaging in community dwelling older adults: the cardiovascular health study. J Am Coll Cardiol 2011; 57:2172-80. [PMID: 21596233 DOI: 10.1016/j.jacc.2011.01.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 12/10/2010] [Accepted: 01/02/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the associations of mitral annular calcification, aortic annular calcification, and aortic valve sclerosis with covert magnetic resonance imaging (MRI)-defined brain infarcts. BACKGROUND Clinically silent brain infarcts defined by MRI are associated with increased risk for cognitive decline, dementia, and future overt stroke. Left-sided cardiac valvular and annular calcifications are suspected as risk factors for clinical ischemic stroke. METHODS A total of 2,680 CHS (Cardiovascular Health Study) participants without clinical histories of stroke or transient ischemic attack underwent brain MRI in 1992 and 1993, 1 to 2 years before echocardiographic exams (1994 to 1995). RESULTS The mean age of the participants was 74.5 ± 4.8 years, and 39.3% were men. The presence of any annular or valvular calcification (mitral annular calcification, aortic annular calcification, or aortic valve sclerosis), mitral annular calcification alone, or aortic annular calcification alone was significantly associated with a higher prevalence of covert brain infarcts in unadjusted analyses (p < 0.01 for all). In models adjusted for age, sex, race, body mass index, physical activity, creatinine, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking, diabetes, coronary heart disease, and congestive heart failure, the presence of any annular or valve calcification remained associated with covert brain infarcts (risk ratio: 1.24; 95% confidence interval: 1.05 to 1.47). The degree of annular or valvular calcification severity showed a direct relation with the presence of covert MRI findings. CONCLUSIONS Left-sided cardiac annular and valvular calcifications are associated with covert MRI-defined brain infarcts. Further study is warranted to identify mechanisms and determine whether intervening in the progression of annular and valvular calcification could reduce the incidence of covert brain infarcts as well as the associated risk for cognitive impairment and future stroke.
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Affiliation(s)
- Carlos J Rodriguez
- Department of Epidemiology and Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Bismuth J, Garami Z, Anaya-Ayala JE, Naoum JJ, El Sayed HF, Peden EK, Lumsden AB, Davies MG. Transcranial Doppler findings during thoracic endovascular aortic repair. J Vasc Surg 2011; 54:364-9. [DOI: 10.1016/j.jvs.2010.12.063] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/14/2010] [Accepted: 12/18/2010] [Indexed: 11/25/2022]
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Carpenter JP, Carpenter JT, Tellez A, Webb JG, Yi GH, Granada JF. A percutaneous aortic device for cerebral embolic protection during cardiovascular intervention. J Vasc Surg 2011; 54:174-181.e1. [PMID: 21236621 DOI: 10.1016/j.jvs.2010.11.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 09/29/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022]
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Werner N, Zeymer U. Stroke outcomes in patients undergoing percutaneous coronary intervention in clinical practice today. Interv Cardiol 2011. [DOI: 10.2217/ica.11.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Matsuura K, Mogi K, Sakurai M, Kawamura T, Takahara Y. Impact of preexisting cerebral ischemia detected by magnetic resonance imaging and angiography on late outcome after coronary artery bypass surgery. Ann Thorac Surg 2011; 91:665-70. [PMID: 21352976 DOI: 10.1016/j.athoracsur.2010.10.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 10/28/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of preexisting ischemia detected by brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) on long-term survival, and cardiac and neurologic events after coronary artery bypass grafting (CABG). METHODS Of 923 patients who underwent CABG between 1994 and 2007, 887 patients (96.1%) were followed up. Preoperative brain MRI and MRA were performed in 619 patients. Ischemia was detected by brain MRI and MRA in 158 patients (group A), but not in 461 patients (group B). Preoperative characteristics, follow-up survival, and cardiac and neurological events were investigated. RESULTS The average follow-up period was 6.0 ± 4.3 years. Univariate analysis showed that patients in group A (68.5 ± 6.5 years) were older than those in group B (64.5 ± 8.6 years) (p = 0.0001). Preoperative left ventricular ejection fraction was less in group A (0.516 ± 0.175) than in group B (0.556 ± 0.165) (p = 0.02). The prevalence of peripheral vascular disease was higher in group A (14 patients: 8.9%) than in group B (11 patients: 2.4%) (p = 0.001). The rate of on-pump CABG was lower in group A (115 patients; 72.8%) than in group B (383 patients; 83.1%) (p = 0.007). Survival rate was significantly lower (p = 0.062), and freedom from major adverse cardiac event or stroke were significantly lower in group A (p = 0.0002, and p = 0.0001, respectively; log-rank test). However, the Cox proportional hazard model showed that preoperative brain ischemia detected by brain MRI and MRA affected only freedom from neurologic events (p = 0.02; hazard ratio 2.52; 95% confidence interval 1.13 to 5.62), but not survival (p = 0.67) or major adverse cardiac event (p = 0.09). CONCLUSIONS Preexisting ischemic findings on brain MRI and MRA in patients who underwent CABG were related only to long-term freedom from stroke, but were not related to survival or major adverse cardiac event.
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Affiliation(s)
- Kaoru Matsuura
- Department of Cardiovascular Surgery, Funabashi Municipal Medical Center, Chiba, Japan.
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Jurga J, Nyman J, Tornvall P, Mannila MN, Svenarud P, van der Linden J, Sarkar N. Cerebral Microembolism During Coronary Angiography. Stroke 2011; 42:1475-7. [DOI: 10.1161/strokeaha.110.608638] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background and Purpose—
Microemboli observed during coronary angiography can cause silent ischemic cerebral lesions. The aim of this study was to investigate if the number of particulate cerebral microemboli during coronary angiography is influenced by access site used.
Methods—
Fifty-one patients with stable angina pectoris referred for coronary angiography were randomized to right radial or right femoral arterial access. The number of particulate microemboli passing the middle cerebral arteries was continuously registered with transcranial Doppler.
Results—
The median (minimum–maximum range) numbers of particulate emboli were significantly higher with radial 10 (1–120) than with femoral 6 (1–19) access. More particulate microemboli passed the right middle cerebral artery with the radial access.
Conclusions—
This study indicates that the radial access used for coronary angiography generates more particulate cerebral microemboli than the femoral access and thus may influence the occurrence of silent cerebral injuries.
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Affiliation(s)
- Juliane Jurga
- From Cardiology Unit, Department of Medicine (J.J., P.T., M.N.M., N.S.), and Department of Molecular Medicine and Surgery (J.N., P.S., J.v.d.L.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Nyman
- From Cardiology Unit, Department of Medicine (J.J., P.T., M.N.M., N.S.), and Department of Molecular Medicine and Surgery (J.N., P.S., J.v.d.L.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- From Cardiology Unit, Department of Medicine (J.J., P.T., M.N.M., N.S.), and Department of Molecular Medicine and Surgery (J.N., P.S., J.v.d.L.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maria Nastase Mannila
- From Cardiology Unit, Department of Medicine (J.J., P.T., M.N.M., N.S.), and Department of Molecular Medicine and Surgery (J.N., P.S., J.v.d.L.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Svenarud
- From Cardiology Unit, Department of Medicine (J.J., P.T., M.N.M., N.S.), and Department of Molecular Medicine and Surgery (J.N., P.S., J.v.d.L.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jan van der Linden
- From Cardiology Unit, Department of Medicine (J.J., P.T., M.N.M., N.S.), and Department of Molecular Medicine and Surgery (J.N., P.S., J.v.d.L.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nondita Sarkar
- From Cardiology Unit, Department of Medicine (J.J., P.T., M.N.M., N.S.), and Department of Molecular Medicine and Surgery (J.N., P.S., J.v.d.L.), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Edmonds HL, Isley MR, Sloan TB, Alexandrov AV, Razumovsky AY. American Society of Neurophysiologic Monitoring and American Society of Neuroimaging Joint Guidelines for Transcranial Doppler Ultrasonic Monitoring. J Neuroimaging 2011; 21:177-83. [DOI: 10.1111/j.1552-6569.2010.00471.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nietlispach F, Wijesinghe N, Gurvitch R, Tay E, Carpenter JP, Burns C, Wood DA, Webb JG. An embolic deflection device for aortic valve interventions. JACC Cardiovasc Interv 2011; 3:1133-8. [PMID: 21087748 DOI: 10.1016/j.jcin.2010.05.022] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/19/2010] [Accepted: 05/21/2010] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We describe initial human experience with a novel cerebral embolic protection device. BACKGROUND Cerebral emboli are the major cause of procedural stroke during percutaneous aortic valve interventions. METHODS With right radial artery access, the embolic protection device is advanced into the aortic arch. Once deployed a porous membrane shields the brachiocephalic trunk and the left carotid artery deflecting emboli away from the cerebral circulation. Embolic material is not contained or removed by the device. The device was used in 4 patients (mean age 90 years) with severe aortic stenosis undergoing aortic balloon valvuloplasty (n = 1) or transcatheter aortic valve implantation (n = 3). RESULTS Correct placement of the embolic protection device was achieved without difficulty in all patients. Continuous brachiocephalic and aortic pressure monitoring documented equal pressures without evidence of obstruction to cerebral perfusion. Additional procedural time due to the use of the device was 13 min (interquartile range: 12 to 16 min). There were no procedural complications. Pre-discharge cerebral magnetic resonance imaging found no new defects in any of 3 patients undergoing transcatheter aortic valve implantation and a new 5-mm acute cortical infarct in 1 asymptomatic patient after balloon valvuloplasty alone. No patient developed new neurological symptoms or clinical findings of stroke. CONCLUSIONS Embolic protection during transcatheter aortic valve intervention seems feasible and might have the potential to reduce the risk of cerebral embolism and stroke.
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Affiliation(s)
- Fabian Nietlispach
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Tuseth V, Nordrehaug JE. Role of percutaneous left ventricular assist devices in preventing cerebral ischemia. Interv Cardiol 2009. [DOI: 10.2217/ica.09.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Clergeau MR, Hamon M, Morello R, Saloux E, Viader F, Hamon M. Silent Cerebral Infarcts in Patients With Pulmonary Embolism and a Patent Foramen Ovale. Stroke 2009; 40:3758-62. [DOI: 10.1161/strokeaha.109.559898] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marie-Rose Clergeau
- From the Services de Cardiologie (M.-R.C., E.S., Ma.H.) and Radiologie (Mi.H.), Univ Caen, CHU de Caen, Normandy, France; INSERM U919 (Mi.H.), UMR CNRS 6232 Ci-NAPS, GIP Cyceron, France; Biostatistique et Recherche Clinique (R.M.), Neurologie (F.V.), and INSERM U 923 (F.V.), Caen, France; and INSERM U 744 (M.H.), Institut Pasteur de Lille, Lille, France
| | - Michèle Hamon
- From the Services de Cardiologie (M.-R.C., E.S., Ma.H.) and Radiologie (Mi.H.), Univ Caen, CHU de Caen, Normandy, France; INSERM U919 (Mi.H.), UMR CNRS 6232 Ci-NAPS, GIP Cyceron, France; Biostatistique et Recherche Clinique (R.M.), Neurologie (F.V.), and INSERM U 923 (F.V.), Caen, France; and INSERM U 744 (M.H.), Institut Pasteur de Lille, Lille, France
| | - Rémy Morello
- From the Services de Cardiologie (M.-R.C., E.S., Ma.H.) and Radiologie (Mi.H.), Univ Caen, CHU de Caen, Normandy, France; INSERM U919 (Mi.H.), UMR CNRS 6232 Ci-NAPS, GIP Cyceron, France; Biostatistique et Recherche Clinique (R.M.), Neurologie (F.V.), and INSERM U 923 (F.V.), Caen, France; and INSERM U 744 (M.H.), Institut Pasteur de Lille, Lille, France
| | - Eric Saloux
- From the Services de Cardiologie (M.-R.C., E.S., Ma.H.) and Radiologie (Mi.H.), Univ Caen, CHU de Caen, Normandy, France; INSERM U919 (Mi.H.), UMR CNRS 6232 Ci-NAPS, GIP Cyceron, France; Biostatistique et Recherche Clinique (R.M.), Neurologie (F.V.), and INSERM U 923 (F.V.), Caen, France; and INSERM U 744 (M.H.), Institut Pasteur de Lille, Lille, France
| | - Fausto Viader
- From the Services de Cardiologie (M.-R.C., E.S., Ma.H.) and Radiologie (Mi.H.), Univ Caen, CHU de Caen, Normandy, France; INSERM U919 (Mi.H.), UMR CNRS 6232 Ci-NAPS, GIP Cyceron, France; Biostatistique et Recherche Clinique (R.M.), Neurologie (F.V.), and INSERM U 923 (F.V.), Caen, France; and INSERM U 744 (M.H.), Institut Pasteur de Lille, Lille, France
| | - Martial Hamon
- From the Services de Cardiologie (M.-R.C., E.S., Ma.H.) and Radiologie (Mi.H.), Univ Caen, CHU de Caen, Normandy, France; INSERM U919 (Mi.H.), UMR CNRS 6232 Ci-NAPS, GIP Cyceron, France; Biostatistique et Recherche Clinique (R.M.), Neurologie (F.V.), and INSERM U 923 (F.V.), Caen, France; and INSERM U 744 (M.H.), Institut Pasteur de Lille, Lille, France
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Röther J, Laufs U, Böhm M, Willems S, Scheller B, Borggrefe M, Darius H, Endres M, Zeymer U, Diener HC, Grond M, Hacke W, Forsting M, Schumacher M, Hennerici M. Konsensuspapier „Peri- und postinterventioneller Schlaganfall bei Herzkatheterprozeduren“. DER KARDIOLOGE 2009. [DOI: 10.1007/s12181-009-0214-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maekawa K, Goto T, Baba T, Yoshitake A, Morishita S, Koshiji T. Abnormalities in the Brain Before Elective Cardiac Surgery Detected by Diffusion-Weighted Magnetic Resonance Imaging. Ann Thorac Surg 2008; 86:1563-9. [DOI: 10.1016/j.athoracsur.2008.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/07/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
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Kreis AJ, Nguyen T, Rogers S, Wang JJ, Harper CA, Clark DJ, Farouque HO, Wong TY. Acute Retinal Arteriolar Emboli After Cardiac Catheterization. Stroke 2008; 39:3086-7. [DOI: 10.1161/strokeaha.108.516591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background and Purpose—
There are concerns that cardiac catheterization may cause retinal embolization, a risk marker for cerebrovascular emboli and stroke. We describe the incidence of acute retinal embolism after cardiac catheterization.
Methods—
One hundred unselected patients attending a tertiary referral center for diagnostic cardiac catheterization were recruited. Digital retinal photography (optic disc and macular fields) was performed precatheterization and within 3 hours postcatheterization. New retinal emboli were identified by a senior researcher and confirmed by a retinal specialist.
Results—
There was one case of retinal embolus precatheterization. Two patients (incidence 2.02%; 95% CI, 0.25 to 7.11) developed new retinal arteriolar emboli after catheterization. No patient developed clinically apparent visual or neurological changes.
Conclusions—
The risk of acute retinal embolism immediately after cardiac catheterization is 2%. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of cardiac catheterization.
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Affiliation(s)
- Andreas J. Kreis
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
| | - Thanh Nguyen
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
| | - Sophie Rogers
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
| | - Jie Jin Wang
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
| | - C. Alex Harper
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
| | - David J. Clark
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
| | - H.M. Omar Farouque
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
| | - Tien Y. Wong
- From the Centre for Eye Research Australia (A.J.K., T.N., S.R., J.J.W., C.A.H., T.Y.W.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Cardiology (D.J.C., H.M.O.F.), Austin Hospital and University of Melbourne, Melbourne, Australia; and the Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National
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Pfeifer R, Ferrari M, Börner A, Deufel T, Figulla HR. Serum concentration of NSE and S-100b during LVAD in non-resuscitated patients. Resuscitation 2008; 79:46-53. [DOI: 10.1016/j.resuscitation.2008.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 03/27/2008] [Accepted: 04/24/2008] [Indexed: 10/21/2022]
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