Cerebrovascular events complicating cardiac catheterization - A tertiary care cardiac centre experience

• Published in: Heart views Vol. 22; no. 4; pp. 264 - 270
• Main Authors: Shivashankarappa, Arun, Mahadevappa, Nagesh, Palakshachar, Anand, Bhat, Prabhavathi, Barthur, Ashita, Bangalore, Sripal, Chikkaswamy, Srinivas, Katheria, Rockey, Nanjappa, Manjunath
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01-10-2021; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Acute coronary syndromes; Cardiac catheterization; Cardiovascular disease; cerebrovascular events; coronary angiography; Intubation; Medical research; Medicine, Experimental; Mortality; Original; percutaneous coronary interventions; Ticagrelor; Transluminal angioplasty; Cardiac catheterization; cerebrovascular events; percutaneous coronary interventions; coronary angiography
• ISSN: 1995-705X; 0976-5123
• DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_42_21

Background: Cerebrovascular events (CVEs) are one of the rare complications of cardiac catheterization. This prospective single-center study was conducted to assess the incidence, presentations, and outcomes of CVEs in patients undergoing cardiac catheterization.
Methods: Patients undergoing cardiac catheterization who developed CVEs within 48 h of procedure were analyzed prospectively with clinical assessment and neuroimaging.
Results: Out of 55,664 patients, 35 had periprocedural CVEs (0.063%). The incidence of periprocedural CVEs with balloon mitral valvotomy, percutaneous coronary intervention, and coronary angiography was 0.127%, 0.112%, and 0.043%, respectively. A larger proportion of periprocedural CVEs occurred in patients with acute coronary syndrome (ACS, 77.1%) than in patients with stable coronary artery disease (CAD). The majority of CVEs were ischemic type (33 patients, 94.3%). It was most commonly seen in the left middle cerebral artery (MCA) territory. Hemorrhagic CVEs were very rare (2 patients, 5.7%). The majority of the CVEs manifested during or within 24 h of the procedure (31 patients, 88.6%). Neurodeficits persisted during the hospital stay in 20 patients (57.2%), who had longer duration of procedure compared to those with recovered deficits (P = 0.0125). In-hospital mortality occurred in three patients (8.5%) and post-discharge mortality in another 3 (8.5%).
Conclusions: Periprocedural CVEs are rare and have decreased over time. They occur in a greater proportion in patients with ACS than in patients with stable CAD, more with interventional than diagnostic procedures. Ischemic event in the left MCA territory is the most common manifestation, commonly seen within 24 h of the procedure. Longer duration of procedure was a risk factor for larger infarcts and hence persistent neurodeficit at discharge. Although a substantial number of patients recover the neurodeficits, periprocedural CVEs are associated with adverse outcomes.