Ischemic cerebrovascular complications of cardiac procedures.

The interactions between heart disease and stroke are close and well known. Advances in therapeutics are leading to the development of a broad gamut of interventions, including medical, surgical, and endovascular procedures that are aimed at improving outcomes in persons with severe heart disease. In particular, innovative surgical and endovascular procedures are being used to treat patients who otherwise could not be treated. Unfortunately, these procedures may be accompanied by neurological complications that result in considerable morbidity or even death. Stroke and neuropsychological impairments are well-recognized complications of cardiovascular operations.1,2 In addition, cerebrovascular events may follow endovascular procedures, especially those that involve catheterization of the left side of the heart.3 Although these complications are relatively uncommon, they do have a negative impact on outcomes and survival.4 The patterns of brain injury include global brain ischemia secondary to hypotension or hypoxia that may cause coma or an encephalopathy; localized brain ischemia secondary to hypoperfusion that appears in a watershed (border zone) or that primarily affects the posterior cerebral hemispheres and leads to visual loss and cognitive deficits; neurotoxicity secondary to contrast agents; intracranial hemorrhage resulting from an idiopathic coagulopathy or from antithrombotic medications; and acute ischemic stroke secondary to embolization of thrombi, air, debris or pieces of atherosclerotic plaque.5 Besides overt strokes, patients undergoing cardiovascular procedures may have long-term neuropsychological sequelae, including memory loss or impaired executive functioning.5,6 In addition, brain imaging performed after procedures also may detect clinically silent or subtle ischemic strokes.5,7