Embolic Lesion Patterns After Transradial Cerebral Angiography: A Secondary Analysis of a Randomized Controlled Trial

Area of Science:

• Neurology
• Radiology
• Cardiovascular Interventions

Background:

• Silent cerebral embolization is a frequent complication of transradial cerebral angiography.
• Diffusion-weighted imaging (DWI) detects these embolic lesions, but their patterns and causes are not fully understood.

Purpose of the Study:

• To analyze embolic lesion patterns after transradial cerebral angiography.
• To identify procedural determinants, particularly heparin strategies, influencing lesion distribution and burden.

Main Methods:

• Secondary analysis of a randomized controlled trial involving patients undergoing transradial cerebral angiography.
• Evaluation of embolic lesion characteristics (multiplicity, laterality, size, burden) on postoperative DWI.
• Multivariable Poisson regression to determine factors associated with lesion incidence and patterns.

Main Results:

• Embolic lesions were detected in 16.9% of 456 patients.
• Most lesions were small and cortical; 29.9% had multiple lesions and 22.1% had bilateral involvement.
• Higher Fazekas grade and longer procedure duration correlated with DWI-positive lesions. Continuous heparinized saline flush was associated with more diffuse lesion patterns.

Conclusions:

• Embolic lesions after transradial cerebral angiography exhibit diverse patterns beyond simple incidence.
• Assessing lesion multiplicity, laterality, and burden offers a detailed view of embolic injury.
• Procedural factors, like continuous pressurized heparinized saline flush, significantly influence embolic risk and lesion distribution.