Introduction: Peri-procedural cardiac catheterization related stroke (CRS) remains a feared complication. Risk estimates reach 7% but vary widely by institution and operator experience. Given the volume (>2 million/yr in US), the impact of CRS is substantial. Evidence-based data on diagnosis/treatment are lacking for these patients despite being ideal targets for acute stroke treatment. Many CRS go undetected due to a lack of a standardized assessment tool.
Hypothesis: A novel screening tool will be feasible to perform and effective in standardizing rapid diagnosis of CRS.
Methods: Two validated tools form the basis of this screen 1) Aldrete score: 10-pt scale used in anesthesia cases to assess activity, respiration, circulation, consciousness and color 2)FAST screen designed to reliably diagnose stroke in < 1 min: Facial droop, Arm weakness, Speech changes, Time. Patients are assessed pre/post procedure and catheterization sheath left in place until protocol completion to allow for CRS IA therapy. Feasibility criteria: Excellent if ≥80%; moderate if ≥50% had successful completion. Uni/multivariable logistic regression analysis assessed interaction with age, sedation & sheath location.
Results: 906 patients were enrolled over 7 months. Mean age was 64.9±13.6; 65% male. 727 cases completed 100% of Aldrete-FAST (80.2%, 95% CI: 77.5% - 82.8%). High dose Midazolam (>2mg) was associated with completion of Aldrete-FAST (P<0.001, OR 3.14 CI:1.79-5.52) while Fentanyl (100-200mcg) was a deterrent (P 0.027, OR 0.45 CI: 0.22-0.91). Fentanyl >200mcg had no association (30 patients). 748 maintained the sheath (88.0%, 95%CI: 85.6%-90.1%). There was no association between age, sex or access site location (femoral, radial or both) on outcomes.
Conclusions: This single-center prospective study demonstrates that the Aldrete-FAST score is a simple, safe screening tool with excellent feasibility to evaluate for CRS. No association between age, sex or access site implies generalizability. We found an interaction with sedation as midazolam and fentanyl had an inverse relationship regarding successful completion of the score. Further study is warranted to determine the optimal anesthesia for high risk patients undergoing cardiac catheterization.