Cerebrovascular Events Complicating Cardiac Catheterization - A Tertiary Care Cardiac Centre Experience

Arun B Shivashankarappa; Nagesh C Mahadevappa; Anand Palakshachar; Prabhavathi Bhat; Ashita Barthur; Sripal Bangalore; Srinivas B Chikkaswamy; Rockey Katheria; Manjunath C Nanjappa

doi:10.4103/HEARTVIEWS.HEARTVIEWS_42_21

Cerebrovascular Events Complicating Cardiac Catheterization - A Tertiary Care Cardiac Centre Experience

Heart Views. 2021 Oct-Dec;22(4):264-270. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_42_21. Epub 2022 Feb 11.

Authors

Arun B Shivashankarappa¹, Nagesh C Mahadevappa¹, Anand Palakshachar¹, Prabhavathi Bhat¹, Ashita Barthur², Sripal Bangalore³, Srinivas B Chikkaswamy¹, Rockey Katheria⁴, Manjunath C Nanjappa¹

Affiliations

¹ Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengalore, Karnataka, India.
² Department of Radiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
³ Department of Cardiology, New York University of Medicine, New York, USA.
⁴ Department of Cardiology, Sakra World Hospital, Bengaluru, Karnataka, India.

PMID: 35330653
PMCID: PMC8939382
DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_42_21

Abstract

Background: Cerebrovascular events (CVEs) are one of the rare complications of cardiac catheterization. This prospective single-center study was conducted to assess the incidence, presentations, and outcomes of CVEs in patients undergoing cardiac catheterization.

Methods: Patients undergoing cardiac catheterization who developed CVEs within 48 h of procedure were analyzed prospectively with clinical assessment and neuroimaging.

Results: Out of 55,664 patients, 35 had periprocedural CVEs (0.063%). The incidence of periprocedural CVEs with balloon mitral valvotomy, percutaneous coronary intervention, and coronary angiography was 0.127%, 0.112%, and 0.043%, respectively. A larger proportion of periprocedural CVEs occurred in patients with acute coronary syndrome (ACS, 77.1%) than in patients with stable coronary artery disease (CAD). The majority of CVEs were ischemic type (33 patients, 94.3%). It was most commonly seen in the left middle cerebral artery (MCA) territory. Hemorrhagic CVEs were very rare (2 patients, 5.7%). The majority of the CVEs manifested during or within 24 h of the procedure (31 patients, 88.6%). Neurodeficits persisted during the hospital stay in 20 patients (57.2%), who had longer duration of procedure compared to those with recovered deficits (P = 0.0125). In-hospital mortality occurred in three patients (8.5%) and post-discharge mortality in another 3 (8.5%).

Conclusions: Periprocedural CVEs are rare and have decreased over time. They occur in a greater proportion in patients with ACS than in patients with stable CAD, more with interventional than diagnostic procedures. Ischemic event in the left MCA territory is the most common manifestation, commonly seen within 24 h of the procedure. Longer duration of procedure was a risk factor for larger infarcts and hence persistent neurodeficit at discharge. Although a substantial number of patients recover the neurodeficits, periprocedural CVEs are associated with adverse outcomes.

Keywords: Cardiac catheterization; cerebrovascular events; coronary angiography; percutaneous coronary interventions.