Author + information
- Hüseyin Göksülük1,
- Sadi Gulec2,
- Yusuf Atmaca1,
- Cansın Kaya1,
- Başar Candemir2,
- Nil Özyüncü1,
- seda kürklü2 and
- Çetin Erol1
Silent cerebral infarcts, which can be detect with elevation of neuron specific enolase, defined as lack of acute stroke-like symptoms and associated with more subtle neurological deficits. Transradial approach is performed successfully and effectively in many catheterization laboratories worldwide. However, safety and effectiveness of transradial access according to side (right vs. left) is stil controversial, especially in the settings of the silent cerebral infarct. We aimed to compare the silent cerebral infarct detected with neuron specific enolase, between left and right transradial approach in patients who underwent percutaneous coronary intervention/diagnostic coronary angiography.
A total of 167 patients scheduled for elective PCI/coronary angiography from right and left transradial access site were assessed for SCI. The patients were divided into two groups: right radial approach group (n=81) and left radial approach group (n=86). NSE levels were studied before and 12 hour after the procedure. Elevation of greater than 0.12μg/l was considered as SCI.
Silent cerebral infarct was observed significantly less common in right radial group than in left radial group (19 [24%] vs. 34 [40%], p=0.03). Baseline characteristics of study patients are seen in Table. When patients were divided into 2 groups according to SCI occurance, patients with SCI were more likely to have hyperlipidemia(70% vs. 51%, p=0.02), history of smoking(42% vs. 17%, p=0.001) and prior myocardial infarction (40% vs. 6%, p<0.001). Multivariate analysis demonstrated history of smoking status (OR:0.378; 95% CI:0.167-0.857; p=0.02) and prior MI (OR:0.116; 95% CI: 0.043-0.309; p<0.001) as independent predictors of SCI. Access site tended to be related with the predicting of silent cerebral infarct by multivariate analysis (OR: 0.509; 95% CI:0.241-1.075; p=0.07).
|Variable||Left radial access (n=86)||Right radial access (n=81)||P value|
|Waist circumference, (cm)||103±12||99±9||0.04|
|Prior myocardial infarction||17(20%)||11(14%)||0.3|
|Silent cerebral infarct||34(40%)||19(24%)||0.03|
|Bare metal stent||0.9±1.2||0.4±0.7||0.04|
Right transradial access has a lower risk of silent cerebral embolization, may due to less mechanical trauma to the arcus aorta wall caused by catheters and wire. Because of patients with silent brain infarcts were considered as a high-risk group for development of neurocognitive disorders, transradial approach should be implemented more carefully during cardiovascular interventions.
ENDOVASCULAR: Stroke and Stroke Prevention