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Cerebral microemboli during left heart catheterization
1Department of Neurology, University of the Saarland, Homburg/Saar, Germany.
Insights
Microemboli signals (MES) are common during left heart catheterization (LHC), often caused by microbubbles from contrast media. Reducing gas content in fluids significantly lowers MES rates, which appear clinically silent.
Area of Science:
- Neuroscience
- Cardiology
- Medical Imaging
Background:
- Microemboli signals (MES) are a potential complication during left heart catheterization (LHC).
- Understanding the incidence and sources of MES during LHC is crucial for patient safety.
Purpose of the Study:
- To quantify the rate of cerebral microemboli signals (MES) during left heart catheterization (LHC).
- To identify the primary sources of MES during LHC procedures.
Main Methods:
- Transcranial Doppler ultrasonography was used to monitor middle cerebral arteries for MES during LHC.
- Seventy-two patients undergoing LHC and 29 patients undergoing LHC with subsequent coronary intervention were studied.
Main Results:
- A mean of 95 +/- 45 MES were detected during standardized LHC, with 67.5% linked to contrast/saline injection.
- Rotablation during coronary interventions showed a massive increase in MES.
- Using injection fluids with lower gas content reduced MES by 67% (P < .05).
- All detected MES were clinically silent.
Conclusions:
- Cerebral microembolism is a frequent occurrence during LHC.
- The findings suggest that microbubbles, not solid emboli, are the main cause of MES during diagnostic LHC.
- High MES rates during rotablation may stem from cavitation bubbles; clinical outcomes of these MES appear benign.
Background:
The aim of this study was to describe the rate of microemboli signals (MES) during left heart catheterization (LHC).
Methods:
A monitoring of both middle cerebral arteries using transcranial Doppler ultrasonography was performed to investigate cerebral microemboli during LHC. Seventy-two patients undergoing LHC and 29 patients with LHC followed by coronary intervention were studied.
Results:
During a standardized LHC (n = 52), 95 +/- 45 MES were detected of which 67.5% occurred during injection of contrast media or saline solution, 30% during movements of wire and catheter, and 2% during catheter manipulation. During coronary interventions only, rotablation (n = 2) was followed by a massive increase in MES. The use of injection fluids prepared with minor gas content reduced the MES rate by 67% (P <.05). All MES were clinically silent.
Conclusions:
Cerebral microembolism is a current finding during LHC. The dependence of the MES rate during diagnostic LHC on the gas content of the injection fluids provides evidence that most of the MES are caused by microbubbles and not by solid emboli. The high rate of MES during coronary rotablation may be explained by the formation of cavitation bubbles. The clinical results of the MES during LHC appear to be benign.