Author + information
- Hüseyin Göksülük1,
- Sadi Gulec2,
- Nil Özyüncü1,
- Seda Kürklü2,
- Demet Uludağ1,
- Semih Öztürk2 and
- Çetin Erol1
Elevation of NSE in the absence of any clinically apparent stroke or transient ischemic attack, so called silent cerebral infarcts (SCIs), may be associated with neurological disorders and mortality. Silent cerebral damage occur during cardiac procedures with a frequency of 15 to 22%. We aimed to investigate elevation of NSE after cardiac procedures on the prediction of silent cerebral infarct to compare the effect of the arterial access site.
Patients scheduled for elective PCI and coronary angiography from transfemoral and transradial access site were assessed for SCI. Study population consisted of two groups of patients: Group 1 included 126 consecutive patients with transfemoral access, whereas Group 2 consisted of 129 patients with transradial access. NSE levels were studied before and 12 hour after the procedure.Elevation of greater than 0.12μg/l was considered as SCI.
Seventy-four of 255 study patients (29%) had SCI after the procedure. NSE elevation was significantly more prevalant among patients with transradial access than transfemoral aproach (36% in the transradial patients (n=47) versus 21% in the transfemoral patients (n=27), p=0.008).When patients were divided into 2 groups according to SCI occurance, patients with SCI were more likely to have hyperlipidemia, history of smoking and prior myocardial infarction (Table). Multivariate analysis demonstrated history of smoking status (OR:0.186; 95% CI:0.094-0.369; p<0.001), prior MI (OR:0.141; 95% CI: 0.064-0.310; p<0.001) and access site (OR:0.405; 95% CI: 0.209-0.785; p = 0.007) as independent predictors of SCI.
|Variable||Silent cerebral infarct (+) (n=74)||Silent cerebral infarct (-) (n=181)||P value|
|Age, mean ± SD, (years)||60±10||62±10||0.09|
|Hypertansion||54 (73%)||130 (72%)||0.9|
|Diabetes Mellitus||22 (30%)||71 (39%)||0.2|
|Prior myocardial infarction||31 (42%)||14(8%)||<0.001|
|Prior coronary bypass||10 (14%)||13 (7%)||0.1|
In our study, transradial catheterization is associated with a significant increase in silent cerebral infarct detected with neuron specific enolase compared to transfemoral catheterization. The risk of silent cerebral injury during coronary procedures may be related to the vascular access site. Increased recognition of SCIs may facilitate preventing their occurrence and decrease the risk of adverse neurological outcomes.
ENDOVASCULAR: Stroke and Stroke Prevention