Cardiac catheterization: neurologic complications

H Steven Block MD (Dr. Block of the Dean Clinic in Madison, Wisconsin has no relevant financial relationships to disclose.)
Sarkis Morales-Vidal MD (Dr. Morales-Vidal of the Stritch School of Medicine at Loyola University of Chicago has no relevant financial relationships to disclose.)
Jose Biller MD (Dr. Biller of the Stritch School of Medicine at Loyola University of Chicago has no relevant financial relationships to disclose.)
Originally released March 14, 2012; last updated September 19, 2016; expires September 19, 2019

Neurologic complications following diagnostic cardiac catheterization and percutaneous coronary interventions occur infrequently but will likely be encountered by the practicing neurologist. In this article, the authors review the incidence and mechanisms of various procedure-related nervous system injuries, with an emphasis on stroke. Various coronary stent types and requirements for antithrombotic therapy to maintain stent patency have a significant implication on bleeding risk, especially intracranially. This risk is further magnified when the patient requires both anticoagulant therapy and dual antiplatelet therapy. The effects of acute kidney injury, which may be caused by radiographic contrast, as well as chronic renal failure's impact on procedural stroke are discussed. Catheter arterial access locations, their risks, and potential benefits as well as peripheral nervous system complications of such are reviewed.

Key points

 

• Cardiac catheterization is successfully performed in large numbers of patients worldwide for both diagnostic and therapeutic purposes. Complications involving both the central and peripheral nervous systems may occur. Although the risk of cardiac catheterization expressed in percentages is low, the neurologist is likely to encounter a catheterization-induced complication given the high volume of patients evaluated and treated by this modality.

 

• Stroke can occur by a variety mechanisms following cardiac catheterization.

 

• Treatment strategies of stroke following cardiac catheterization need to be based on the type of intervention and concurrent medications used during the cardiac procedure.

 

• Medications required to avoid stent thrombosis may produce hemorrhagic complications.

 

• Specific peripheral nerve injuries can occur as a consequence of cardiac catheterization.

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