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Stroke, Vol 23, 1358-1359, Copyright © 1992 by American Heart Association

ARTICLES

The preponderance of posterior circulatory events is independent of the route of cardiac catheterization

GR Keilson, WJ Schwartz and LD Recht
Department of Neurology, University of Massachusetts Medical Center, Worcester 01655.

BACKGROUND AND PURPOSE: Central nervous system complications of cardiac catheterization are most often attributed to embolic events that occur at the time of catheter manipulation. Nevertheless, the reason that over 50% of these events are localized to the posterior circulation remains unexplained. One potential explanation offered for this preponderance is the use of the brachial artery approach. In this report, we examined the relation between the route of catheterization and central nervous system complications. SUMMARY OF REPORT: We retrospectively analyzed all central nervous system complications that occurred after cardiac catheterization through a femoral route at our institution over a 3 1/2-year period. Thirteen patients were identified as having central nervous system complications. Using defined criteria, posterior circulatory events still accounted for at least 54% of central nervous system complications. CONCLUSIONS: The preponderance of posterior circulatory events is apparently independent of the route of catheterization. Furthermore, given the array of neurological symptoms and their often complete resolution, we feel it is unlikely that embolism is the sole pathophysiological mechanism involved in these events.

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