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Stroke after cardiac catheterization

Authors
Robert A Taylor, MD
Pooja Khatri, MD, MSc
Section Editors
Scott E Kasner, MD
Donald Cutlip, MD
Deputy Editors
John F Dashe, MD, PhD
Gordon M Saperia, MD, FACC

INTRODUCTION

Stroke resulting from cardiac catheterization is relatively common due to the high volume of cardiac procedures performed worldwide. This topic will review periprocedural stroke in the setting of cardiac catheterization, which includes diagnostic and interventional procedures. Other aspects of acute stroke are discussed elsewhere. (See "Initial assessment and management of acute stroke" and "Intravenous fibrinolytic (thrombolytic) therapy in acute ischemic stroke: Therapeutic use".)

MECHANISMS

Patients may experience either ischemic or hemorrhagic stroke in the setting of cardiac catheterization.

Ischemic stroke — In most cases, the mechanism of ischemic stroke is directly related to cardiac catheterization itself, which initially involves advancing catheters over wires into the aorta, generally using either transfemoral or transradial access. Catheter or wire manipulation may dislodge debris made up of thrombus, calcific material, or cholesterol particles from atherosclerotic plaques within the aortic arch and the proximal carotid and vertebral arteries [1-4]. In addition, fresh thrombus material may form at the catheter and guidewire tips. Most cases of ischemic stroke related to cardiac catheterization are caused by such thromboemboli. (See "Embolism from atherosclerotic plaque: Atheroembolism (cholesterol crystal embolism)".)

The mechanism of ischemic stroke is similar between diagnostic and interventional procedures. However, interventional catheters are on average larger than diagnostic catheters and the procedures are often longer and thus there may be a theoretical increase in risk.

Ultimately, one or more catheters end up in one of the cardiac chambers or in the coronaries arteries. Catheterization across a degenerated aortic valve may lead to thromboembolism and the risk of stroke may be particularly high in patients with significant valvular aortic stenosis (AS) who undergo retrograde catheterization of the aortic valve [5,6]. This was demonstrated in a study of 152 patients with AS (mean age 71 years) who were randomly assigned to cardiac catheterization with or without catheter passage through the valve [5]. The following findings were noted:

              

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Literature review current through: Nov 2016. | This topic last updated: Wed Jun 01 00:00:00 GMT 2016.
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