Cerebral infarcts after coronary angiography and percutaneous coronary intervention. A prospective propensity score adjusted comparison of right radial, left radial and femoral approaches

Nicola Marchese, Massimiliano Copetti, Vincenzo Inchingolo, Teresa Popolizio, Andrea Fontana, Annalisa Simeone, Carlo Vigna

Research output: Contribution to journalArticlepeer-review

Abstract

Background: New cerebral infarcts (CIs) detected at magnetic resonance imaging (MRI) are reported after cardiac procedures. Clinical and procedural aspects are implicated as potential causal factors. The aim of this study was to evaluate the incidence of new CIs after coronary angiography and percutaneous coronary intervention according to the arterial access site. Methods: 180 patients undergoing elective coronary angiography were studied with cerebral MRI the day before and the day after the procedure. Unadjusted and propensity score (PS) analyses were performed comparing the occurrence of CIs in right radial (RR), left radial (LR) and transfemoral (TF) access groups. Results: New CIs were observed in 14 patients (7.8% of the total sample, one with neurological sequelae). CIs were detected in 15.5% vs 4.9% vs 3.3% of RR, LR and TF groups, respectively (p =.026). In PS adjusted analyses, the RR approach was associated with more CIs compared with the TF approach (odds ratio [OR] estimate from logistic regression adjusted by PS quartiles: 0.158; 95% confidence interval: 0.031 to 0.814; p =.027) and the LR approach (OR: 0.266; 95% confidence interval: 0.066 to 1.080; p =.064). In a secondary analysis, a comparison of RR vs non-RR approach (TF + LR) was performed, showing that post-procedural CIs were more frequent in the RR group (OR: 0.170; 95% confidence interval: 0.050 to 0.574; p =.004). Conclusions: Our study suggests that the RR approach may be associated with a higher rate of new CIs after coronary angiography compared with LR and TF approaches.

Original languageEnglish
JournalCardiovascular Revascularization Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2019

Keywords

  • Cerebral infarct
  • Femoral access
  • Radial access

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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