title: Cerebral emboli during left heart catheterization may cause acute brain injury.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Rikshospitalet University Hospital, 0027 Oslo, Norway. christian.lund@rikshospitalet.no
authors.forename: Christian
authors.initials: C
authors.lastname: Lund
authors.forename: Ragnhild Bang
authors.initials: RB
authors.lastname: Nes
authors.forename: Torhild Pynten
authors.initials: TP
authors.lastname: Ugelstad
authors.forename: Paulina
authors.initials: P
authors.lastname: Due-Tønnessen
authors.forename: Rune
authors.initials: R
authors.lastname: Andersen
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Hol
authors.forename: Rainer
authors.initials: R
authors.lastname: Brucher
authors.forename: David
authors.initials: D
authors.lastname: Russell
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D018608:Ultrasonography, Doppler