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Coronary Angiography Complicated by Acute Ischaemic Stroke and the Use of Thrombolysis: a Cardiology Perspective and Narrative Review of Current Literature

  • Interventional Cardiology (SR Bailey and T Helmy, Section Editors)
  • Published:
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Abstract

Purpose of Review

Coronary angiography–associated acute ischaemic stroke (CAAIS) is an uncommon event but is associated with significant mortality and morbidity. The incidence of CAAIS has increased with a rise in the volume of coronary angiography (CA) and percutaneous coronary intervention (PCI) performed. Intravenous thrombolysis (IVT) is utilized in the general management of acute ischaemic stroke; however, it is associated with a higher risk of intracranial hemorrhage (ICH). As CA or PCI is performed more often in an aging population or high-risk patients that also carry an increased risk of ICH, it is vital to minimize additional complications from the treatment of CAAIS. This article aims to review the pathophysiological mechanisms for CAAIS, clarify the current evidence regarding IVT use in this setting, and thus assist cardiologists in the management of CAAIS.

Recent Findings

The pathophysiology for CAAIS may be different from acute ischaemic stroke in the general population. Embolic phenomena from dislodgement of calcium or other debris during manipulation of instrumentation during CA or PCI are likely mechanisms. This may contribute to altered thrombus composition, which affects the efficacy of IVT as suggested in recent studies. Furthermore, IVT in the management of CAAIS has not been evaluated specifically.

Summary

The utilization of IVT should be carefully considered in CAAIS given a paucity of evidence demonstrating safety and efficacy in this setting. A multidisciplinary pathway that emphasizes the involvement of cardiologists in the treatment decision-making process would aid in thoughtful risk-benefit evaluation for IVT use in CAAIS and reduce adverse patient outcomes. Future studies to assess the impact of this pathway on CAAIS outcomes would be beneficial.

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Authors and Affiliations

  1. Department of Cardiology, Austin Health, Melbourne, VIC, Australia

    Julian Gin, Julian Yeoh, Vincent Thijs, David Clark, Mark Horrigan, Omar Farouque & Ali Al-Fiadh

  2. Department of Neurology, Austin Health, Melbourne, VIC, Australia

    Vincent Thijs & Jan Kee Ho

  3. Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia

    Vincent Thijs

  4. Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia

    Julian Yeoh, David Clark, Mark Horrigan, Omar Farouque & Ali Al-Fiadh

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Gin, J., Yeoh, J., Thijs, V. et al. Coronary Angiography Complicated by Acute Ischaemic Stroke and the Use of Thrombolysis: a Cardiology Perspective and Narrative Review of Current Literature. Curr Cardiol Rep 25, 1499–1512 (2023). https://doi.org/10.1007/s11886-023-01962-y

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