Thursday, August 2, 2012

Cardiac Catheterizations Cause Small Risk of Stroke and Other Neurological Complications

MAYWOOD, Ill. - 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.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.