Braekken S K, Endresen K, Russell D, Brucher R, Kjekshus J
Department of Neurology, Rikshospitalet, The National Hospital, University of Oslo, Norway.
Am J Cardiol. 1998 Sep 1;82(5):632-7. doi: 10.1016/s0002-9149(98)00407-x.
Cerebral embolization is a serious complication during diagnostic heart catheterization. To date there have been no studies to determine whether the technique and the catheter type influence the frequency of cerebral microembolic signals (MES's) during left ventricular catheterization. Twenty-two patients had a leading straight tip guidewire protruding 5 to 10 cm outside the coronary catheters when the latter was advanced over the aortic arch (group A), whereas in 21 patients the guidewire was withdrawn in the descending part of the aorta (group B). Transcranial Doppler of the left middle cerebral artery was performed to monitor the number of cerebral MES's. When a protruding guidewire was used to advance the coronary catheters over the aortic arch, MES's were detected in 86% of the patients compared with 29% when the catheters were advanced without a guidewire (relative risk = 4.6, p = 0.00001). The number of MES's per patient also was significantly higher when a guidewire was used (median 9 vs 0) (p = 0.000004). In group A, a higher number of MES's was detected when a right Judkins catheter was advanced over the aortic arch than when a left Judkins catheter was advanced (median 6.5 vs 1) (p = 0.0005) and in patients who previously had a myocardial infarction than in those who had not (median 1 1 vs 4) (p = 0.007). This study strongly suggests that the risk of embolization is greater when straight tip guidewires are used to advance catheters over the aortic arch during left ventricular heart catheterization, especially in patients with a history of myocardial infarction.
脑栓塞是诊断性心导管插入术中的一种严重并发症。迄今为止，尚无研究确定该技术和导管类型是否会影响左心室导管插入术期间脑微栓塞信号（MES）的发生频率。22例患者在冠状动脉导管经主动脉弓推进时，有一根直头导丝在冠状动脉导管外伸出5至10厘米（A组），而21例患者的导丝在主动脉降部被撤回（B组）。对左大脑中动脉进行经颅多普勒检查以监测脑MES的数量。当使用伸出的导丝将冠状动脉导管经主动脉弓推进时，86%的患者检测到MES，而导管在无导丝情况下推进时这一比例为29%（相对风险=4.6，p=0.00001）。使用导丝时每位患者的MES数量也显著更高（中位数9比0）（p=0.000004）。在A组中，右Judkins导管经主动脉弓推进时检测到的MES数量高于左Judkins导管经主动脉弓推进时（中位数6.5比1）（p=0.0005），并且既往有心肌梗死的患者检测到的MES数量高于无心肌梗死的患者（中位数11比4）（p=0.007）。这项研究强烈表明，在左心室心导管插入术期间，当使用直头导丝经主动脉弓推进导管时，尤其是有心肌梗死病史的患者，栓塞风险更大。
