Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications

Ischaemic stroke is the most common neurological complication of cardiac catheterisation. This study aims to analyse the clinical and prognostic differences between post-catheterisation stroke code (SC) and all other in-hospital and prehospital SC. We prospectively recorded SC activation at our centre between March 2011 and April 2016. Patients were grouped according to whether SC was activated post-catheterisation, in-hospital but not post-catheterisation, or before arrival at hospital; groups were compared in terms of clinical and radiological characteristics, therapeutic approach, functional status, and three-month mortality. The sample included 2224 patients, of whom 31 presented stroke post-catheterisation. Baseline National Institutes of Health Stroke Scale score was lower for post-catheterisation SC than for other in-hospital SC and pre-hospital SC (5, 10, and 7, respectively; P = .02), and SC was activated sooner (50, 100, and 125 minutes, respectively; P < .001). Furthermore, post-catheterisation SC were more frequently due to transient ischaemic attack (38%, 8%, and 9%, respectively; P < .001) and less frequently to proximal artery occlusion (17.9%, 31.4%, and 39.2%, respectively; P = .023). The majority of patients with post-catheterisation strokes (89.7%) did not receive reperfusion therapy; 60% of the patients with proximal artery occlusion received endovascular treatment. The mortality rate was 12.95% for post-catheterisation strokes and 25% for all other in-hospital strokes. Although patients with post-catheterisation stroke had a better functional prognosis, the adjusted analysis showed that this effect was determined by their lower initial severity. Post-catheterisation stroke is initially less severe, and presents more often as transient ischaemic attack and less frequently as proximal artery occlusion. Most post-catheterisation strokes are not treated with reperfusion; in case of artery occlusion, mechanical thrombectomy is the preferred treatment. El ictus es la complicación neurológica más frecuente tras una coronariografía. Nuestro objetivo fue estudiar las diferencias clínicas y pronósticas entre los códigos ictus (CI) poscateterismo y el resto de CI intra y extrahospitalarios. Registro prospectivo de activación de CI entre marzo de 2011 y abril de 2016 en nuestro centro. Comparamos características clínicas, radiológicas, tratamiento administrado, situación funcional y mortalidad a 3 meses dependiendo de si se trató de un CI poscateterismo, del resto de CI intrahospitalarios o extrahospitalarios. De 2.224 activaciones de CI 31 fueron poscateterismo. Los CI poscateterismo presentaron una NIHSS basal menor respecto al resto de CI intrahospitalarios y extrahospitalarios (5 vs. 10 vs. 7 respectivamente, p = 0,02), mayor rapidez en la activación (50 min vs. 100 min vs. 125 min, p < 0,001), mayor presentación en forma de AIT (38% vs. 8% vs. 9%, p < 0,001) y menor tasa de oclusión arterial proximal (17,9% vs. 31.4% vs. 39.2%, p = 0,023). El 89,7% de ictus poscateterismo no recibieron tratamiento de reperfusión. En caso de oclusión arterial proximal el 60% recibió tratamiento endovascular. La mortalidad fue del 12,95% en los CI poscateterismo y del 25% en el resto de CI intrahospitalarios. Aunque los ictus poscateterismo presentaron mejor pronóstico funcional, el análisis ajustado mostró que este efecto estaba determinado por su menor gravedad inicial. El ictus poscateterismo tiene una menor gravedad inicial, aparece más frecuentemente como AIT y presenta menor incidencia de oclusión arterial proximal. La mayoría no recibe tratamiento de reperfusión, pero cuando existe oclusión arterial, la mayor parte de ellos son tratados mediante trombectomía.