Risk of stroke from cardiac catheterizations

When a patient undergoes a cardiac catheterization procedure such as a balloon angioplasty, there's a slight risk of a stroke or other neurological complications.

While the risk is extremely small, neurologists nevertheless may expect to see catheterization-induced complications because so many procedures are performed, Loyola neurologists write in the journal MedLink Neurology.

Cardiac catheterizations include diagnostic angiograms, balloon angioplasties and stent placements. More than 1.4 million procedures are successfully performed each year. Cardiac catheterizations, like all medical treatments, carry some degree of risk. But because the risk is low, neurologists rarely see patients who experience neurological complications. The purpose of the MedLink article is to raise awareness of the risks and to list treatment options when complications do occur.

The procedure involves inserting a catheter (thin tube) in the groin or arm and guiding it to the heart. In rare cases, debris can be knocked loose from blood vessel walls, travel to the brain and trigger a stroke or transient ischemic attack (mini stroke). Tiny bubbles released from the catheter also can trigger a stroke or transient ischemic attack. And bleeding in the groin or arm where the catheter is inserted can cause peripheral nerve damage.

However, the risk is slight. And with the use of more refined techniques and smaller and softer catheters, the risk is getting even smaller, said H. Steven Block, MD, first author of the review article.

“We want to be careful to not scare people who need a cardiac catheterization from getting this beneficial procedure,” Block said.

Indeed, because the incidence is so low, it is difficult to perform randomized clinical trials to determine the best treatment for catheterization-induced neurologic complications, the authors write.

“Cardiac catheterization is a very safe procedure,” Block added. “A lot of neurologists may encounter neurologic complications only once or twice during their careers. But we would like to raise awareness and knowledge, so they are better prepared when a case does happen.”

Block is a mid-career neurology fellow at Loyola. Co-authors are Loyola neurologists Sarkis Morales-Vidal, MD; Alejandro Hornik, MD; and José Biller, MD. Biller is chair of Loyola's Department of Neurology.

The article was edited by Steven R. Levine, MD, of the SUNY Health Science Center in Brooklyn. N.Y.

Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 28 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 569-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb Memorial Hospital campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.