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Stroke as a complication of cardiac catheterization: risk factors and clinical features
A Z Segal1, W B Abernethy, I F Palacios
1Department of Neurology, Cornell University Medical Center, New York, NY 10021, USA. azs2001@mail.med.cornell.edu
Insights
Stroke complicating cardiac catheterization is linked to severe coronary artery disease and longer fluoroscopy times. Diffusion-weighted MRI helps identify asymptomatic lesions and lacunar infarcts, likely due to atheroembolism.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cardiac catheterization is a common procedure.
- Stroke is a potential complication of cardiac catheterization.
- Understanding risk factors and imaging patterns is crucial for patient management.
Purpose of the Study:
- To identify risk factors for stroke after cardiac catheterization.
- To describe the radiologic patterns of stroke in this context.
- To correlate imaging findings with potential causes.
Main Methods:
- A case-control study design was employed.
- Twenty-two cases of stroke complicating cardiac catheterization were matched with three control subjects.
- Magnetic Resonance Imaging (MRI) with diffusion weighting was utilized for imaging.
Main Results:
- Stroke was significantly associated with the severity of coronary artery disease (Odds Ratio [OR] 1.96).
- Increased length of fluoroscopy time was also a significant risk factor (OR 1.65).
- Diffusion-weighted MRI identified multiple asymptomatic lesions and 23% lacunar-type infarcts, suggesting an atheroembolic origin.
Conclusions:
- Severity of coronary artery disease and prolonged fluoroscopy are key risk factors for stroke post-cardiac catheterization.
- Diffusion-weighted MRI is valuable for detecting subtle and asymptomatic ischemic lesions.
- Atheroembolism is a likely mechanism for a subset of these strokes.
Abstract:
The authors aimed to delineate the risk factors and radiologic pattern of stroke complicating cardiac catheterization. Twenty-two cases were matched with three control subjects. Stroke was significantly associated with severity of coronary artery disease and length of fluoroscopy time (OR 1.96 and 1.65). The use of MRI with diffusion weighting allowed the identification of multiple asymptomatic lesions and a subset of lacunar-type infarcts (23%), which most likely occurred on an atheroembolic basis.