-Original-

Incidence and Clinical Significance of Ischemic Stroke Following Cardiac Catheterization

Hiroki Goda¹, Yukichi Tokita¹, Keisuke Inui¹, Shunichi Nakamura¹, Yoshiaki Kubota¹, Koji Murai¹, Koji Kato¹, Yasuhiro Nishiyama², Seiji Okubo^2,3, Hitoshi Takano¹, Kazumi Kimura² and Kuniya Asai¹

¹Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
²Department of Neurology, Nippon Medical School, Tokyo, Japan
³Department of Neurology, NTT Medical Center Tokyo, Tokyo, Japan

Background: Ischemic stroke (IS) is one of the most serious complications after cardiac catheterization. This study aimed to investigate the incidence of IS in patients undergoing cardiac catheterization as well as the risk factors and neurological prognosis of IS.
Methods: We retrospectively analyzed the data of consecutive 2,848 patients (age 69.1 ± 11.1 years, 2,118 men) who underwent cardiac catheterization from January 2011 to December 2013 to determine the incidence and clinical outcomes of IS.
Results: Thirteen patients (0.46%) developed IS after cardiac catheterization, necessitating treatment in the stroke care unit. Multivariate analysis identified five unmodifiable risk factors (age, atrial fibrillation, current smoking, prior stroke, and prior coronary artery bypass graft surgery) and two modifiable risk factors (additional internal thoracic artery angiography and the transbrachial approach) associated with IS. The initial National Institutes of Health Stroke Scale score was 6.9 ± 9.3 at the onset of IS, which improved to 3.1 ± 8.2 at the time of discharge. Five patients demonstrated complete recovery at discharge (modified Rankin Scale [mRS] score = 0), seven demonstrated residual neurological deficit (mRS = 2.7 ± 1.7, including two cases of severe deficit), and one patient died in hospital (mRS = 6).
Conclusions: Although rare, IS following cardiac catheterization is associated with significant morbidity and mortality. Avoiding unnecessary internal thoracic artery angiography and the brachial approach may reduce the incidence, and appropriate use of anticoagulants or thrombolytics may improve the prognosis and decrease residual neurological deficits.

J Nippon Med Sch 2025; 92: 360-367

Keywords
ischemic stroke, cardiac catheterization, risk factor, The National Institutes of Health Stroke Scale score, modified Rankin Scale

Correspondence to
Yukichi Tokita, MD, PhD, Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
yukichi@nms.ac.jp

Received, March 1, 2025
Accepted, May 27, 2025