Incidence and Clinical Significance of Ischemic Stroke Following Cardiac Catheterization
Hiroki Goda1, Yukichi Tokita1, Keisuke Inui1
1Department of Cardiovascular Medicine, Nippon Medical School.
Insights
Ischemic stroke (IS) after cardiac catheterization is rare but serious. Identifying risk factors like age and atrial fibrillation, and avoiding certain procedures, can help prevent IS and improve patient outcomes.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Ischemic stroke (IS) is a significant complication following cardiac catheterization.
- Understanding the incidence, risk factors, and prognosis of IS is crucial for patient care.
Purpose of the Study:
- To determine the incidence of IS after cardiac catheterization.
- To identify risk factors associated with IS.
- To evaluate the neurological prognosis of patients experiencing IS.
Main Methods:
- Retrospective analysis of 2,848 patients undergoing cardiac catheterization between January 2011 and December 2013.
- Multivariate analysis to identify risk factors for IS.
- Assessment of neurological outcomes using the National Institutes of Health Stroke Scale and modified Rankin Scale.
Main Results:
- The incidence of IS was 0.46% (13 patients).
- Unmodifiable risk factors included age, atrial fibrillation, smoking, prior stroke, and prior coronary artery bypass graft surgery.
- Modifiable risk factors identified were additional internal thoracic artery angiography and the transbrachial approach.
- Most patients showed improvement in stroke scale scores by discharge, with varying degrees of recovery.
Conclusions:
- IS following cardiac catheterization, though rare, leads to significant morbidity and mortality.
- Avoiding specific procedures like internal thoracic artery angiography and the brachial approach may reduce IS incidence.
- Optimizing anticoagulant or thrombolytic therapy could improve prognosis and reduce neurological deficits.
Background:
Ischemic stroke (IS) is one of the most serious complications after cardiac catheterization. This study aimed to investigate the incidence of IS in patients undergoing cardiac catheterization as well as the risk factors and neurological prognosis of IS.
Methods:
We retrospectively analyzed the data of consecutive 2,848 patients (age 69.1 ± 11.1 years, 2,118 men) who underwent cardiac catheterization from January 2011 to December 2013 to determine the incidence and clinical outcomes of IS.
Results:
Thirteen patients (0.46%) developed IS after cardiac catheterization, necessitating treatment in the stroke care unit. Multivariate analysis identified five unmodifiable risk factors (age, atrial fibrillation, current smoking, prior stroke, and prior coronary artery bypass graft surgery) and two modifiable risk factors (additional internal thoracic artery angiography and the transbrachial approach) associated with IS. The initial National Institutes of Health Stroke Scale score was 6.9 ± 9.3 at the onset of IS, which improved to 3.1 ± 8.2 at the time of discharge. Five patients demonstrated complete recovery at discharge (modified Rankin Scale [mRS] score = 0), seven demonstrated residual neurological deficit (mRS = 2.7 ± 1.7, including two cases of severe deficit), and one patient died in hospital (mRS = 6).
Conclusions:
Although rare, IS following cardiac catheterization is associated with significant morbidity and mortality. Avoiding unnecessary internal thoracic artery angiography and the brachial approach may reduce the incidence, and appropriate use of anticoagulants or thrombolytics may improve the prognosis and decrease residual neurological deficits.
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