Potential embolization by atherosclerotic debris dislodged from aortic wall during cardiac catheterization: Histologic and clinical findings in 7,621patients

Embolic events during cardiac catheterization have been attributed to ather osclerotic aortic debris dislodged by catheter manipulation. We evaluated t he frequency and the histologic morphology of atherothrombotic material ret rieved during placement of coronary catheters in patients undergoing diagno stic or interventional cardiac procedures. Over a 4-year period, macroscopi cally visible aortic debris from coronary catheters, if present after advan cement to the ascending aorta, was obtained for histologic examination. In 41 of 7,621 patients (0.54%), visible atherothrombotic material was present in the backflow of catheters. Debris occurred most frequently with 8 Fr gu iding catheters (98%). Histologic examination showed foam cells, cholestero l crystals, and amorphic lipoid substance as markers of atheromatous materi al from atherosclerotic plaques in 38/41 patients (93%) with former plaque hemorrhage in 55% of them. In three patients, fresh thrombus material was o bserved (7%). None of these patients showed in-hospital ischemic complicati ons. Although visible atheromatous material is a rare phenomenon in cardiac catheterization, an increased risk of scraping debris is associated with l arge-lumen guiding catheters. In order to avoid vascular embolization, the use of smaller guiding catheters and sufficient free backflow of catheters after advancement are recommended. (C) 2000 Wiley-Liss, Inc.