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Published on: September 20, 2020
Cerebral microembolism during coronary angiography: a randomized comparison between femoral and radial arterial
Juliane Jurga1, Jesper Nyman, Per Tornvall
1Cardiology Unit, Department of Medicine, Karolinska University Hospital, Solna, N3:05, SE 171 76 Stockholm, Sweden. juliane.jurga@karolinska.se
Insights
Coronary angiography using radial access generates more cerebral microemboli than femoral access, potentially increasing silent ischemic brain injuries. This finding highlights a key difference in procedural risks.
Area of Science:
- Cardiovascular Interventions
- Cerebrovascular Research
- Medical Device Technology
Background:
- Coronary angiography is a common procedure for diagnosing heart conditions.
- Particulate cerebral microemboli during angiography are linked to silent ischemic cerebral lesions.
- The choice of arterial access site may influence microemboli generation.
Purpose of the Study:
- To determine if the arterial access site impacts the number of cerebral microemboli during coronary angiography.
- To compare microemboli generation between radial and femoral access routes.
Main Methods:
- A randomized controlled trial involving 51 patients with stable angina pectoris.
- Patients were assigned to either right radial or right femoral arterial access for coronary angiography.
- Transcranial Doppler was used for continuous monitoring of particulate microemboli in the middle cerebral arteries.
Main Results:
- Significantly higher median numbers of particulate microemboli were observed with radial access (10) compared to femoral access (6).
- The right middle cerebral artery experienced a greater passage of particulate microemboli with radial access.
- Individual patient data showed a wide range in emboli counts for both access sites.
Conclusions:
- Radial access for coronary angiography is associated with a higher generation of particulate cerebral microemboli compared to femoral access.
- The increased microemboli from radial access may contribute to a higher risk of silent cerebral injuries.
- Further research is warranted to explore the clinical implications of these findings.
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.
