Cardiac catheterization: neurologic complications

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.)
Camilo R Gomez MD (Dr. Gomez of Loyola University Chicago, Stritch School of Medicine, has no relevant financial relationships to disclose.)
H Steven Block MD (Dr. Block of the Dean Clinic in Madison, Wisconsin 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.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released March 14, 2012; last updated March 5, 2018; expires March 5, 2021

Neurologic complications following diagnostic cardiac catheterization and percutaneous coronary interventions occur infrequently but are likely to 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 the potential impact of chronic renal failure 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.

 

• Neurologic complications involving both the central and peripheral nervous systems, although infrequent, are important cause of neurologic consultations given the high volume of patients evaluated and treated with these techniques.

 

• Stroke, the most dreaded complication, can occur by a variety of 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 (eg, compression, traction, laceration).

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