Lazar J M, Uretsky B F, Denys B G, Reddy P S, Counihan P J, Ragosta M
Cardiac Catheterization Laboratories, University of Pittsburgh Medical Center, Pennsylvania, USA.
Am J Cardiol. 1995 May 15;75(15):1056-60. doi: 10.1016/s0002-9149(99)80724-3.
The reported incidence of acute neurologic complications of left heart catheterization varies from 0.03% to 0.3%. The predisposing risk factors, clinical features, and natural history have not been well characterized. We retrospectively reviewed all cases of acute neurologic complications developing during or within 36 hours of diagnostic catheterization or angioplasty to determine the incidence, clinical features, and natural history, and (using a case-control methodology) the clinical variables associated with their development. During the 37-month study, 6,465 patients underwent diagnostic left-sided cardiac catheterization and balloon angioplasty or valvuloplasty, and 27 patients developed an acute neurologic complication (0.4%). The most common symptoms were visual disturbances (26%), hemiparesis (26%), and facial droop (26%). Deficits were localizable to the anterior or posterior circulation in 22 patients: posterior in 8 (36%), and anterior in 14 (64%). Long-term follow-up was available in all patients, with 17 of 27 (63%) having complete resolution with no residuum. With use of a case-control methodology and multiple logistic regression analysis, female gender, the presence of left ventricular hypertrophy, depressed ejection fraction, and the presence of > or = 2 coronary arteries with > 50% narrowing were independent predictors of a neurologic event.
据报道，左心导管插入术急性神经并发症的发生率在0.03%至0.3%之间。其诱发风险因素、临床特征及自然病史尚未得到充分描述。我们回顾性分析了诊断性导管插入术或血管成形术期间或术后36小时内发生的所有急性神经并发症病例，以确定其发生率、临床特征和自然病史，并（采用病例对照方法）确定与其发生相关的临床变量。在为期37个月的研究中，6465例患者接受了左侧心脏诊断性导管插入术、球囊血管成形术或瓣膜成形术，27例患者出现急性神经并发症（0.4%）。最常见的症状为视觉障碍（26%）、偏瘫（26%）和面部下垂（26%）。22例患者的神经功能缺损定位于前循环或后循环：8例（36%）定位于后循环，14例（64%）定位于前循环。所有患者均进行了长期随访，27例中有17例（63%）完全恢复，无残留症状。采用病例对照方法和多元逻辑回归分析，女性、左心室肥厚、射血分数降低以及存在≥2支冠状动脉狭窄>50%是神经事件的独立预测因素。
