By Juliane Jurga, MD
While discussing coronary angiography and neurological complications a senior colleague claimed that he, by using the original Judkins technique with guidewire withdrawal in the descending aorta, had avoided causing a single stroke during his 30 year long career. Intrigued, as the technique used in our cath-lab, and in many others worldwide, is guidewire withdrawal in the ascending aorta, we wanted to see if his statement could be scientifically proven or was only senile swagger.
Stroke is today considered a rare complication,<sup>1</sup> but this may be a false assumption. Recent studies have reported a high incidence of cerebral microemboli during coronary angiography,<sup>2,3</sup> and that they can cause small cerebral lesions presenting more subtle clinical symptoms, such as cognitive impairment.<sup>4</sup>
We designed a randomized study comparing the two guidewire techniques by monitoring the occurrence of cerebral microemboli and found that, in this case, eldest may be the wisest. Judkins technique consistently generated fewer cerebral microemboli and, consequently, maybe this technique should be used by all interventional cardiologists.
Although further proof of concept is required, the result of this study is of clinical significance. Overall, surprisingly few studies have so far been done on the safety of currently used techniques and materials, and cognitive impairment as neurological complication is, to date, an unexplored territory. Considering that an increasing number of coronary angiographies are now being performed on a gradually older and more fragile patient population, it’s time for large trials investigating the correlation between cerebral microemboli, cerebral lesions and their clinical consequences.
- Jurga J, Tornvall P, van der Linden J, Sarkar N. Guidewire Withdrawal in Ascending Aorta Increases Cerebral Microembolism During Coronary Angiography — A Randomized Comparison of Two Guidewire Techniques. J INVASIVE CARDIOL 2014;26(1):1-6.
- Sankaranarayanan R, Msairi A, Davis GK. Stroke complicating cardiac catheterization–a preventable and treatable complication. J Invasive Cardiol. 2007;19:40-45.
- Busing KA, Schulte-Sasse C, Fluchter S, et al. Cerebral infarction: incidence and risk factors after diagnostic and interventional cardiac catheterization–prospective evaluation at diffusion-weighted MR imaging. Radiology. 2005;235:177-183.
- Hamon M, Gomes S, Clergeau MR, et al. Risk of acute brain injury related to cerebral microembolism during cardiac catheterization performed by right upper limb arterial access. Stroke. 2007 38:2176-2179.
- Lund C, Nes RB, Ugelstad TP, et al. Cerebral emboli during left heart catheterization may cause acute brain injury. Eur Heart J. 2005;26:1269-1275.
A selection of articles highlighting Guidewire Technique available at http://www.invasivecardiology.com:
- Marmagkiolis K, Cilingiroglu M. Radi pressurewire rupture and embolization to the right common carotid artery after crossing a Bjork-Shiley mechanical aortic valve. J Invasive Cardiol. 2013 Oct;25(10):E191-E193.
- Deora S, Vyas C, Shah S. Percutaneous transvenous mitral commissurotomy – a modified over-the-wire technique for difficult left ventricle entry. J Invasive Cardiol. 2013 Sep;25(9):471-473.
- Michael TT, Banerjee S, Brilakis ES. Subintimal distal anchor technique for “balloon-uncrossable” chronic total occlusions. J Invasive Cardiol. 2013 Oct;25(10):552-554.
- Takahashi Y, Okazaki H, Mizuno K. Transvenous IVUS-guided percutaneous coronary intervention for chronic total occlusion: a novel strategy. J Invasive Cardiol. 2013 Jul;25(7):E143-E146.