Neurological complications of coronary angiographic procedures

Neurological complications of coronary angiographic procedures are uncommon, varied and can include central nervous toxicity caused by contrast agents (contrast reactions), as well as ischemic and hemorrhagic stroke. These complications are rare; however, more recent data derived from neuroimaging studies suggest that there is a higher incidence of 'silent' ischemic events. The impact of these subclinical events is still uncertain, but a few studies suggest that long term they may lead to cognitive decline, which is usually subtle. The clinical presentation of both contrast reactions and strokes can, at times, be very similar as there is a higher than expected incidence of posterior circulation involvement with both. While the treatment of contrast reactions is usually supportive, treatment of ischemic stroke in patients undergoing catheterization procedures appears, based on limited case report series, to lead to favorable outcomes with immediate neuroangiographic intervention, including local administration of recombinant-type tissue plasminogen activator.