title: Guidewire withdrawal in ascending aorta increases cerebral microembolism during coronary angiography: a randomized comparison of two guidewire techniques.
abstract: BACKGROUND
  Microemboli are frequently detected entering the middle cerebral arteries during coronary angiography (CA). Recent studies have reported that cerebral microemboli, especially particulate cerebral microemboli, may cause silent ischemic cerebral lesions.
  
  
  OBJECTIVE
  To investigate whether the occurrence of particulate cerebral microemboli during diagnostic CA is influenced by which guidewire technique is used.
  
  
  METHODS
  Patients with stable angina pectoris or non-ST elevation acute coronary syndrome, referred for CA, were randomized to initial advancement of catheters with a leading guidewire over the aortic arch or to initial guidewire withdrawal in the descending aorta with advancement of catheters alone. After completed CA (part 1), new catheters and guidewires were advanced with guidewire technique contrary to the one first used (part 2). Patients were continuously monitored with transcranial Doppler (TCD), and cerebral microemboli were automatically counted and differentiated.
  
  
  RESULTS
  Statistical analysis was performed on 41 patients. The results in part 1 were confirmed in part 2. The median number (interquartile range) of particulate cerebral microemboli was significantly higher when catheters were advanced with, compared to without, a guidewire over the aortic arch; overall, 6 (IQR, 1-9) vs 1 (IQR, 0-3); P=.01.
  
  
  CONCLUSIONS
  Advancement of catheters with a leading guidewire over the aortic arch with subsequent flushing in the ascending aorta consistently generated more particulate cerebral microemboli, implying that the choice of guidewire technique has an impact on the risk for cerebral lesions during CA.
authors.affiliation: Department of Cardiology, Karolinska University Hospital/Solna, N3:05, SE 171 76 Stockholm, Sweden. Email: juliane.jurga@karolinska.se.
authors.forename: Juliane
authors.initials: J
authors.lastname: Jurga
authors.forename: Per
authors.initials: P
authors.lastname: Tornvall
authors.forename: Jan
authors.initials: J
authors.lastname: van der Linden
authors.forename: Nondita
authors.initials: N
authors.lastname: Sarkar
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging; D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000000981:diagnostic imaging; D000925:Anticoagulants / Q000627:therapeutic use; D001011:Aorta; D001013:Aorta, Thoracic; D017023:Coronary Angiography / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D005260:Female; D000077425:Fondaparinux; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D000077425:Fondaparinux