Over 1.4 million cardiac catheterization procedures (CCPs) take place yearly. CPP related stroke incidence in 1973 was reported as 0.23%. CCPs are invasive in nature with complications occurring due to unintentional trauma to preexisting atherosclerotic aortic plaques or thrombus formation at catheter/guidewire tips. Less common causes of ischemic stroke are air, left ventricular clot, hypotension, arterial dissection, fractured guidewire. Transient neurological deficits have been reported following high-osmolar contrast injection into carotid/vertebral arteries. With improved practice, current stroke incidence is 0.06%. Performing >4000 procedures in FY 2017, our facility sought to compare our statistics vs. current literature.
Cardiovascular disease was the leading cause of global death in 2013 (17.3 million); stroke close behind at 11.8 million. Ninety-two million Americans live with cardiovascular disease/stroke after effects accruing $316 billion in indirect costs: health expenditures/lost productivity. Seventeen percent of strokes occur in the hospital; with stroke suffered post CCPs having morbidity/mortality rates of 19-37%.Time to recognition/treatment of stroke symptoms is vital to provide best outcomes.
Increase in visual symptoms post CCPs was noted by Procedural Care Unit staff with questionable correlation to radial access usage. Staff education on atypical stroke symptom recognition/empowerment and comfort to initiate Code Stroke protocol was conducted. There was variability in practitioner approach to calling Code Strokes vs. observing patients post symptom recognition. Meetings were held with Cardiology, Neurology, Hospital Administration, Departmental Leadership, Stroke Manager to come to consensus on patient management. There should be a low threshold for performing screening neurologic exams: alertness, speech, visual, sensory, motor symptoms and for calling Code Strokes. With more sensitive diagnostic tools, the process of diagnosis should be streamlined. Real time Code Stroke data was collected from December 2015-November 2017;with final analysis completed in November 2017.The research team consisted of PCU Clinical Manager, PCU Clinical Lead, Stroke Manager.
Data analysis showed 48 Code Strokes called; 30 being confirmed as strokes. Of confirmed cases 67% were male, 63% were radial, 57% had interventional procedures. Presenting symptoms of stroke, in order of frequency, were vision, arm drift/weakness, then facial droop and speech. The typical act FAST stroke assessment tool would not be helpful in the majority of these patients.
Literature shows women have higher stroke risk after CCPs. Our analysis showed higher prevalence in men and with radial access. The most common symptom of visual changes, results in NIHSS scores of 0, which may impact practitioners ordering stroke work-ups; when focus should be on patient disability.