Abstract 17530: Under-Recognized Acute Cerebral Infarction Occurring After the Cardiac Catheterization for the Pre-Op Testing of Cardiothoracic Surgery

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Background and Methods: Diffusion-weighted imaging of MRI enables us to detect ischemic lesions in its hyperacute phase. In this retrospective study, we have analyzed the frequency of acute cerebral infarction that had occurred in patients who underwent cardiac catheterization as per-op screening before cardiothoracic surgery. Clinical information (atherosclerotic risk factors, use of antithrombotic drugs), ultrasonographic findings (left ventricular function, carotid artery atherosclerosis), and catheter procedure-associated factors (site of approach, fluoroscopy time, dose of irradiation, amount of contrast medium) were accumulated.

Results: In total, 104 patients (mean age 70.2 years, male 66.7%) were enrolled, and 19 had atrial fibrillation. Scheduled cardiothoracic surgeries were for: coronary artery disease (n=50), valvular heart disease (n=46), and aortic aneurysm (n=11). Cardiac catheters were introduced via upper limb (n=83) or femoral (n=24) artery. All patients underwent coronary artery evaluation, and left ventriculography was performed in 66 and angiography for the internal thoracic artery (ITA) in 48. Brain MRI, which was also meant to be a pre-op screening, was performed at the mean period of 2.4 (standard deviation [SD], 1.9) days following the cardiac catheterization. Of 104 patients, acute-phase ischemic brain lesion was diagnosed in 19 (18.1%). Patients undergoing angiography for ITA were found to have acute cerebral ischemic lesions more frequently (14/48 [29.2%], P=0.01) than those without ITA angiography (5/56 [8.9%]). Patients with acute cerebral lesion had greater amount of contrast medium (128.0+/-34.0mL) than those without these lesions (100.7+/-38.6mL, P=0.04). Angiography for ITA (odds ratio, 6.1; P=0.01) and the amount of contrast medium (odds ratio, 2.4 per 1 SD increase; P=0.01) were selected to be factors independently associated with acute cerebral ischemia in multivariate logistic regression analysis.

Conclusions: Among patients undergoing cardiac catheterization for the purpose of pre-op evaluation before cardiothoracic surgery, acute cerebral infarction was not a rare occurrence (18%), although they were asymptomatic and did not interfere with the scheduled surgical procedures.

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