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Risk of catheter-related emboli in patients with atherosclerotic debris in the thoracic aorta
D G Karalis1, V Quinn, M F Victor
1Division of Cardiovascular Diseases, Hahnemann University Hospital, Philadelphia, PA 19102, USA.
Insights
Patients with atherosclerotic aortic debris face a higher risk of embolic events during cardiac catheterization, especially with femoral approaches or intraaortic balloon pump use. Mobile debris significantly elevates this risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Atherosclerotic aortic debris, detected via transesophageal echocardiography, poses a potential risk during cardiovascular procedures.
- Identifying patients with aortic debris is crucial for managing procedural risks.
Purpose of the Study:
- To assess the risk of embolic events associated with cardiac catheterization and intraaortic balloon pump (IABP) placement in patients with atherosclerotic aortic debris.
- To identify predictors of aortic debris and evaluate the impact of debris characteristics on embolic risk.
Main Methods:
- Retrospective analysis of patients undergoing cardiac catheterization or IABP placement.
- Comparison of embolic event rates between patients with and without atherosclerotic aortic debris.
- Evaluation of different catheterization approaches (femoral vs. brachial) and IABP use.
Main Results:
- Higher embolic event rates (17%) in patients with debris undergoing femoral catheterization compared to controls (3%).
- No embolic events occurred in patients with debris undergoing brachial catheterization.
- Significant embolic events (50%) in patients with debris receiving IABP, versus 0% in controls.
- Mobile atherosclerotic aortic debris and peripheral vascular disease were associated with the highest risk.
Conclusions:
- Transesophageal echocardiography detection of atherosclerotic aortic debris identifies high-risk patients for embolism.
- Brachial catheterization and avoiding IABP may mitigate embolism risk in patients with aortic debris.
- Mobile aortic debris presents a particularly high risk, warranting careful procedural consideration.
Abstract:
The aim of this study was to evaluate the risk of performing cardiac catheterization or intraaortic balloon pump placement in patients with transesophageal echocardiographically detected atherosclerotic aortic debris. Cardiac catheterization was performed in 70 patients with atherosclerotic aortic debris (in 11 via the brachial approach and in 59 via the femoral approach) and in 71 control patients. An embolic event occurred in 10 (17%) of 59 patients with atherosclerotic aortic debris after femoral catheterization compared to 2 (3%) of 71 control patients without atherosclerotic aortic debris (p = 0.01). None of the 11 patients with atherosclerotic aortic debris who underwent brachial catheterization had an embolic event. An intraaortic balloon pump was placed in 10 patients with atherosclerotic aortic debris and in 12 control patients. An embolic event related to placement of the intraaortic balloon pump occurred in 5 (50%) of 10 patients with atherosclerotic aortic debris; no control patient had an embolic event (p = 0.02). Patients with mobile atherosclerotic aortic debris were at the highest risk for catheter-related embolism. The strongest clinical predictors of atherosclerotic aortic debris were advanced age and peripheral vascular disease. Transesophageal echocardiographic recognition of atherosclerotic aortic debris identifies patients at high risk of stroke or peripheral embolism after cardiac catheterization or intraaortic balloon pump placement. If the aortic debris is mobile, the risk is particularly high. When atherosclerotic aortic debris is detected, especially if the debris is mobile, substituting brachial for femoral catheterization and avoiding placement of an intraaortic balloon pump may reduce the risk of embolism.