PREDISPOSING RISK-FACTORS AND NATURAL-HISTORY OF ACUTE NEUROLOGIC COMPLICATIONS OF LEFT-SIDED CARDIAC-CATHETERIZATION

The reported incidence of acute neurologic complications of left heart catheterization varies from 0.03% to 0.3%. The predisposing risk fact ors, clinical features, and natural history have not been well charact erized. We retrospectively reviewed all cases of acute neurologic comp lications developing during or within 36 hours of diagnostic catheteri zation or angioplasty to determine the incidence, clinical features, a nd natural history, and (using ct case-control methodology) the clinic al variables associated with their development. During the 37-month st udy, 6,465 patients underwent diagnostic left-sided cardiac catheteriz ation and balloon angioplasty or valvuloplasty, and 27 patients develo ped an acute neurologic complication (0.4%). The most common symptoms were visual disturbances (26%), hemiparesis (26%), and facial droop (2 6%). Deficits were localizable to the anterior or posterior circulatio n in 22 patients: posterior in 8 (36%), and anterior in 14 (64%). Long -term follow-vp was available in all patients, with 17 of 27 (63%) hav ing complete resolution with no residuum. With use of a case-control m ethodology and multiple logistic regression analysis, female gender, t he presence of left ventricular hypertrophy, depressed ejection fracti on, and the presence of greater than or equal to 2 coronary arteries w ith >50% narrowing were independent predictors of a neurologic event.