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European Heart Journal Advance Access published online on February 16, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi148
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Cerebral emboli during left heart catheterization may cause acute brain injury

Christian Lund 1*, Ragnhild Bang Nes 2, Torhild Pynten Ugelstad 3, Paulina Due-Tønnessen 4, Rune Andersen 4, Per Kristian Hol 5, Rainer Brucher 6, and David Russell 1

1 Department of Neurology, Rikshospitalet University Hospital, 0027 Oslo, Norway
2 Department of Psychosomatic Medicine, Rikshospitalet University Hospital, 0027 Oslo, Norway
3 Department of Cardiology, Rikshospitalet University Hospital, 0027 Oslo, Norway
4 Department of Radiology, Rikshospitalet University Hospital, 0027 Oslo, Norway
5 The Interventional Centre, Rikshospitalet University Hospital, 0027 Oslo, Norway
6 Department of Medical Engineering, Ulm University of Applied Sciences, Ulm, Germany

* To whom correspondence should be addressed.
Christian Lund, E-mail: christian.lund{at}rikshospitalet.no


  Abstract

Aims Left heart catheterization carries a risk for cerebral complications. The aims of this prospective study were to determine the frequency and composition of catheterization-related cerebral microemboli and to detect cerebral morphological changes and acute cognitive impairment due to catheterization.

Methods and results Forty-seven unselected patients undergoing elective left heart catheterization, either by transradial or by transfemoral access, were monitored for cerebral microemboli using multifrequency transcranial Doppler. Cerebral magnetic resonance imaging (MRI) with diffusion-weighted imaging sequences and neuropsychological assessments were carried out on the day before and the day after catheterization. A median number of 754 cerebral microemboli were detected: 92.1% were gaseous and 7.9% were solid. New cerebral lesions were observed in 15.2% of the transradial, but none of the transfemoral, catheterization patients (P = 0.567). These lesions were significantly associated with a higher number of solid microemboli (P = 0.016) and a longer fluoroscopy time (P = 0.039). There was also a significantly higher number of solid microemboli during transradial than during transfemoral catheterization (P = 0.012). Cognitive impairment following the investigations was associated with the degree of pre-catheterization cerebral MRI injury (P = 0.03).

Conclusion During left heart catheterization, cerebral microemboli, especially those which are solid, may damage the brain. Cardiac catheterization may therefore pose a greater risk for the brain than previously acknowledged.

Keywords: Brain injury; Cardiac catheterization; Cerebral ischaemia; Magnetic resonance imaging; Microemboli; Transcranial Doppler.
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