title: Characteristics, treatment, and outcomes of periprocedural cerebrovascular accidents during electrophysiologic procedures.
abstract: OBJECTIVE
  We sought to identify the characteristics, treatment, and outcomes of periprocedural cerebrovascular accident (PCVA) during electrophysiologic (EP) procedures.
  
  
  BACKGROUND
  Periprocedural cerebrovascular accident is one of the most feared complications during EP procedures with very few data regarding its characteristics, management, and outcomes.
  
  
  METHODS
  Between January 1998 and December 2008, we reviewed 30,032 invasive EP procedures for PCVA occurrence and characteristics. Management and outcomes were also determined.
  
  
  RESULTS
  Thirty-eight CVAs were identified. Twenty (53 %) were intraprocedural and 18 (47 %) postprocedural. Thirty-two (84 %) were classified as strokes and six (16 %) as transient ischemic attacks. All CVAs except one (37, 97 %) were ischemic and the vast majority occurred during ablation procedures (36, 95 %). Among the 31 patients with ischemic stroke, 11 (35 %) were treated with reperfusion (eight catheter-based therapy and three intravenous t-PA) of whom five (46 %) had complete recovery, three (27 %) had partial recovery, and three (27 %) had no recovery. No hemorrhagic transformations occurred.
  
  
  CONCLUSIONS
  Periprocedural cerebrovascular accident during EP procedures is rare and is almost always ischemic. It occurs more frequently during ablation procedures. Reperfusion therapy is feasible and safe.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Serge C
authors.initials: SC
authors.lastname: Harb
authors.forename: George
authors.initials: G
authors.lastname: Thomas
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.forename: Georges N
authors.initials: GN
authors.lastname: Nakhoul
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Hussein
authors.forename: Valeria E
authors.initials: VE
authors.lastname: Duarte
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Thomas
authors.initials: T
authors.lastname: Dresing
authors.forename: Thomas
authors.initials: T
authors.lastname: Callahan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kanj
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Lindsay
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000401:mortality*; D022062:Electrophysiologic Techniques, Cardiac / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome