Neurologic Complications in Patients Undergoing Coronary Angiography and Percutaneous Coronary Intervention–A North Shore Hospital Experience

Background/Aim: Peri-procedural neurologic complications (NC) are associated with significant morbidity and mortality. Aspiration thrombectomy during primary percutaneous coronary intervention (PCI) was routinely practiced at our institution and an increased incidence of NC has recently been reported. We sought to ascertain the incidence of NC related to cardiac catheterisation at North Shore Hospital. Methods: Single centre, retrospective review of all patients undergoing coronary angiography or PCI. Transradial diagnostic cases received 5,000iu unfractionated heparin but not transfemoral. All PCI patients received weight-adjusted heparin to a maximum of 10,000iu. NC was defined as transient or permanent neurological deficits, with or without supportive imaging. Results: 7,877 patients underwent coronary catheterisation over a six-year period. NC occurred in 12/4,244 (0.28%) diagnostic angiography and 16/3,633 (0.44%) PCI patients (p = 0.25). For PCI, NC was more frequent among primary PCI (2.4%) (OR = 10.4, CI 3.7-28.8, p < 0.001). NC rates did not differ between access routes. For diagnostic angiography, transfemoral route was associated with increased NC risk (7/1100, 0.64%) (OR = 4, CI 1.3-12.6, p = 0.01). No NC occurred in patients > 100 kg. Conclusion: Our peri-procedural NC rates are similar to literature reports. Ceiling dose of 10,000iu heparin was not associated with NC in obese patients. NC rates were higher during primary PCI and this may relate to our use of thrombectomy. NC rates were higher during diagnostic angiography via transfemoral route and this may relate to lack of routine heparinisation (as used for transradial route).