Shivashankarappa Arun B, Mahadevappa Nagesh C, Palakshachar Anand, Bhat Prabhavathi, Barthur Ashita, Bangalore Sripal, Chikkaswamy Srinivas B, Katheria Rockey, Nanjappa Manjunath C
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengalore, Karnataka, India.
Department of Radiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Heart Views. 2021 Oct-Dec;22(4):264-270. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_42_21. Epub 2022 Feb 11.
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.
Patients undergoing cardiac catheterization who developed CVEs within 48 h of procedure were analyzed prospectively with clinical assessment and neuroimaging.
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 ( = 0.0125). In-hospital mortality occurred in three patients (8.5%) and post-discharge mortality in another 3 (8.5%).
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.
脑血管事件（CVEs）是心脏导管插入术罕见的并发症之一。本前瞻性单中心研究旨在评估接受心脏导管插入术患者中CVEs的发生率、表现及预后。
对在心脏导管插入术48小时内发生CVEs的患者进行前瞻性临床评估和神经影像学分析。
在55664例患者中，35例发生围手术期CVEs（0.063%）。球囊二尖瓣成形术、经皮冠状动脉介入治疗和冠状动脉造影围手术期CVEs的发生率分别为0.127%、0.112%和0.043%。急性冠状动脉综合征（ACS）患者围手术期CVEs的发生率（77.1%）高于稳定型冠状动脉疾病（CAD）患者。大多数CVEs为缺血性类型（33例，94.3%），最常见于左侧大脑中动脉（MCA）区域。出血性CVEs非常罕见（2例，5.7%）。大多数CVEs在手术期间或术后24小时内出现（31例，88.6%）。20例患者（57.2%）在住院期间神经功能缺损持续存在，与神经功能缺损恢复的患者相比，其手术时间更长（P = 0.0125）。3例患者（8.5%）发生院内死亡，另有3例（8.5%）出院后死亡。
围手术期CVEs罕见且随时间有所下降。ACS患者中CVEs的发生率高于稳定型CAD患者，介入手术中CVEs的发生率高于诊断性手术。左侧MCA区域的缺血事件是最常见的表现，通常在术后24小时内出现。手术时间较长是梗死面积较大及出院时神经功能缺损持续存在的危险因素。尽管大量患者神经功能缺损得以恢复，但围手术期CVEs与不良预后相关。
