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Guidewire withdrawal in ascending aorta increases cerebral microembolism during coronary angiography: a randomized
Juliane Jurga1, Per Tornvall, Jan van der Linden
1Department of Cardiology, Karolinska University Hospital/Solna, N3:05, SE 171 76 Stockholm, Sweden.
Background:
Microemboli are frequently detected entering the middle cerebral arteries during coronary angiography (CA). Recent studies have reported that cerebral microemboli, especially particulate cerebral microemboli, may cause silent ischemic cerebral lesions.
Aims:
To investigate whether the occurrence of particulate cerebral microemboli during diagnostic CA is influenced by which guidewire technique is used.
Methods:
Patients with stable angina pectoris or non-ST elevation acute coronary syndrome, referred for CA, were randomized to initial advancement of catheters with a leading guidewire over the aortic arch or to initial guidewire withdrawal in the descending aorta with advancement of catheters alone. After completed CA (part 1), new catheters and guidewires were advanced with guidewire technique contrary to the one first used (part 2). Patients were continuously monitored with transcranial Doppler (TCD), and cerebral microemboli were automatically counted and differentiated.
Results:
Statistical analysis was performed on 41 patients. The results in part 1 were confirmed in part 2. The median number (interquartile range) of particulate cerebral microemboli was significantly higher when catheters were advanced with, compared to without, a guidewire over the aortic arch; overall, 6 (IQR, 1-9) vs 1 (IQR, 0-3); P=.01.
Conclusions:
Advancement of catheters with a leading guidewire over the aortic arch with subsequent flushing in the ascending aorta consistently generated more particulate cerebral microemboli, implying that the choice of guidewire technique has an impact on the risk for cerebral lesions during CA.
Insights
Guidewire technique during coronary angiography (CA) significantly impacts particulate cerebral microemboli. Advancing catheters with a guidewire over the aortic arch increases microemboli, potentially leading to silent ischemic cerebral lesions.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Particulate cerebral microemboli are detected during coronary angiography (CA) and linked to silent ischemic cerebral lesions.
- The influence of guidewire technique on microemboli generation during CA is not well understood.
Purpose of the Study:
- To determine if different guidewire techniques during diagnostic CA affect the incidence of particulate cerebral microemboli.
Main Methods:
- Patients undergoing CA were randomized to two guidewire techniques: over the aortic arch or withdrawal from the descending aorta.
- Each patient underwent both techniques in separate parts of the study.
- Cerebral microemboli were monitored and counted using transcranial Doppler (TCD).
Main Results:
- A significantly higher median number of particulate cerebral microemboli (6 vs 1) occurred when catheters were advanced with a guidewire over the aortic arch.
- These findings were consistent across both parts of the study.
- The difference in microemboli generation between techniques was statistically significant (P=.01).
Conclusions:
- Advancing catheters with a leading guidewire over the aortic arch generates more particulate cerebral microemboli.
- The choice of guidewire technique during CA influences the risk of cerebral microemboli and potential lesions.
