Central nervous system complications of percutaneous transluminal coronary angioplasty.

During 1968 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures, 4 patients (0.2%) suffered a focal central nervous system complication. Two patients had a hemisphere infarct, one a brainstem infarct and one a hemisphere transient ischemic attack. Embolism was the likely mechanism in 3 cases; in 1 air was injected through the guiding catheter, and in 2 post-coronary bypass cases the ascending aorta was "scraped" with the guiding catheter while searching for a graft ostium. In 1 case the event occurred after a successful PTCA during a period of hypotension. Neurologic complications are rare during PTCA but will occasionally occur as the procedure is performed more frequently.