Type of Vascular Access Not Linked to Silent Cerebral Infarcts

MIAMI BEACH, FLA.—In patients receiving cardiac catheterization for aortic stenosis, the method of vascular access whether femoral or radial does not affect the rate of silent cerebral infarcts, according to data presented here from a multicenter, prospective randomized trial.

Martial Hamon, MD, from the University Hospital of Caen, France, and colleagues looked at 160 patients scheduled for cardiac catheterization to assess coronary artery tree and aortic valve disease before surgery for severe aortic stenosis. Patients were randomized to radial (n=83) or femoral (n=77) access. All investigators were highly experienced in transradial interventions (>70% of their procedures were routinely performed by radial access) and were high volume operators (>300 procedures per year).

Twenty-four patients had positive post-procedural cerebral infarcts on diffusion-weighted magnetic resonance imaging (DW-MRI) and 22 patients remained asymptomatic. New silent cerebral infarcts on DW-MRI occurred with similar frequency whether the vascular access was femoral (11.7%) or radial (17.5%; OR 0.85; 95% CI 0.62-1.16; P=.31).

On multivariable analysis, only higher patient height (OR 8.24; 95% CI 2.71-25.02; P<.0001) and a lower transvalvular gradient (OR 0.96; 95% CI 0.93-0.99; P=.027) were associated with an increased risk of periprocedural cerebral thromboembolism on DW-MRI.

The trial protocol included MRI within 24 hours before and 48 hours after cardiac catheterization. Baseline characteristics of the two groups did not differ except for the greater number of catheters used in the femoral group (P=.01).

High rate of silent infarcts confirmed

Hamon told TCT Daily that the study confirmed that silent brain infarcts occur frequently in left cardiac catheterization, whichever access site is used. Any major concern about the risk of stroke using transradial access (especially right radial access) compared to femoral access “can no longer be supported.” In aortic stenosis patients, short left cardiac catheterization procedures are preferable, he said, and avoiding any unnecessary prolonged attempt to cross the valve for gradient measurement is wise.

If cardiac surgery is indicated after left cardiac catheterization, either valve replacement or CABG, physicians “should consider checking for recent silent brain infarcts that could increase the risk of perisurgical brain hemorrhage,” he advised.

“These silent brain infarcts have been associated with immediate cognitive impairment and an increased risk of symptomatic stroke at long-term follow-up. As patients with CAD will undergo several left cardiac catheterizations in their life, this finding may emerge as a new issue and a potential concern. However, long-term follow-up of a larger series of patients is required to confirm the deleterious impact of silent brain infarcts on patient outcomes,” he said.