Ischemic stroke associated with left cardiac catheterization: the importance of modifiable and non-modifiable risk
Batric Popovic1, Sylvain Carillo, Nelly Agrinier
1CHU Nancy, Département de Cardiologie, Nancy, France. b.popovic@chu-nancy.fr
Insights
Stroke during left cardiac catheterization is a serious risk. High-volume operators and avoiding left ventricular angiography can help reduce stroke occurrence.
Area of Science:
- Cardiology
- Neurology
- Medical Procedures
Background:
- Stroke is a severe complication of left cardiac catheterization with a persistent incidence.
- Understanding risk factors is crucial for stroke prevention in this patient population.
Purpose of the Study:
- To investigate the incidence, in-hospital outcomes, and risk factors for periprocedural ischemic stroke.
- To identify modifiable and non-modifiable factors associated with stroke after left cardiac catheterization.
Main Methods:
- Retrospective cohort study of 24,500 patients undergoing left cardiac catheterization (2003-2010).
- Comparison of patients with periprocedural ischemic stroke (cases) to a randomly selected control group.
- Multivariate analysis to identify independent predictors of stroke.
Main Results:
- The incidence of ischemic stroke was 0.15% (37 patients), with persistent neurological deficit in 28 cases.
- Independent predictors included diabetes, renal dysfunction, prior cerebrovascular disease, emergency procedures, and recent heart failure.
- Modifiable factors identified were left ventricular angiography and low operator volume.
Conclusions:
- Limiting left cardiac catheterization to high-volume operators may decrease stroke risk.
- Avoiding unnecessary left ventricular angiography is a key strategy for stroke prevention.
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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