title: Potential embolization by atherosclerotic debris dislodged from aortic wall during cardiac catheterization:: histological and clinical findings in 7,621 patients.
abstract: Embolic events during cardiac catheterization have been attributed to atherosclerotic aortic debris dislodged by catheter manipulation. We evaluated the frequency and the histologic morphology of atherothrombotic material retrieved during placement of coronary catheters in patients undergoing diagnostic or interventional cardiac procedures. Over a 4-year period, macroscopically visible aortic debris from coronary catheters, if present after advancement to the ascending aorta, was obtained for histologic examination. In 41 of 7,621 patients (0.54%), visible atherothrombotic material was present in the backflow of catheters. Debris occurred most frequently with 8 Fr guiding catheters (98%). Histologic examination showed foam cells, cholesterol crystals, and amorphic lipoid substance as markers of atheromatous material from atherosclerotic plaques in 38/41 patients (93%) with former plaque hemorrhage in 55% of them. In three patients, fresh thrombus material was observed (7%). None of these patients showed in-hospital ischemic complications. Although visible atheromatous material is a rare phenomenon in cardiac catheterization, an increased risk of scraping debris is associated with large-lumen guiding catheters. In order to avoid vascular embolization, the use of smaller guiding catheters and sufficient free backflow of catheters after advancement are recommended.
authors.affiliation: Department of Cardiology, Division of Internal Medicine, University GHS Essen, Germany. holger.eggebrecht@uni-essen.de
authors.forename: H
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: O
authors.initials: O
authors.lastname: Oldenburg
authors.forename: O
authors.initials: O
authors.lastname: Dirsch
authors.forename: M
authors.initials: M
authors.lastname: Haude
authors.forename: D
authors.initials: D
authors.lastname: Baumgart
authors.forename: D
authors.initials: D
authors.lastname: Welge
authors.forename: J
authors.initials: J
authors.lastname: Herrmann
authors.forename: G
authors.initials: G
authors.lastname: Arnold
authors.forename: K W
authors.initials: KW
authors.lastname: Schmid
authors.forename: R
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000473:pathology*; D001161:Arteriosclerosis / Q000473:pathology*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D003328:Coronary Thrombosis / Q000473:pathology; D004867:Equipment Design; D005260:Female; D005487:Foam Cells / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013923:Thromboembolism / Q000473:pathology*