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Cortical blindness during left internal mammary angiography
J S Skinner1, M J Jackson, A Gholkar
1Department of Cardiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
International Journal of Cardiology
|November 24, 1995
Summary
Transient cortical blindness can occur during internal mammary artery angiography due to guidewire manipulation causing emboli. Angiographers should be aware of this neurological risk in coronary artery bypass grafting patients.
Area of Science:
- Cardiovascular medicine
- Neurology
- Interventional radiology
Background:
- Coronary artery bypass grafting (CABG) often requires follow-up angiography.
- Internal mammary artery (IMA) graft angiography is frequently performed for these investigations.
Observation:
- Two cases of transient cortical blindness occurred during selective IMA graft angiography.
- Blindness onset was linked to guidewire manipulation in the left subclavian artery near the vertebral artery origin.
Findings:
- Vertebral angiography showed multiple emboli in the posterior circulation in one patient.
- Neurological deficits resolved within 15 minutes to 3 weeks, with one patient experiencing persistent visual agnosia.
- Emboli from guidewire manipulation are the suspected cause, with possible contribution from vasospasm.
Implications:
- Selective IMA graft angiography may pose a higher neurological complication risk than previously recognized.
- Guidewire use in the subclavian artery during these procedures may increase the risk of embolic events.
- Angiographers should exercise caution during IMA angiography in post-CABG patients to mitigate neurological risks.