DOI: 10.1161/jaha.126.051166 ISSN: 2047-9980

Embolic Lesion Patterns After Transradial Cerebral Angiography: A Secondary Analysis of a Randomized Controlled Trial

Chenchen Liu, Peixin Li, Tiancen Fan, Gang Deng, Yihui Wang, Donghui Ao, Hao Huang, Yi Zhang, Yi Xie, Ying Yu, Qianqian Kong, Guo Li, Shabei Xu, Xiang Luo
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Background

Silent cerebral embolization frequently occurs after transradial cerebral angiography and is commonly detected on diffusion‐weighted imaging (DWI). However, the distribution patterns, burden, and procedural determinants of embolic lesions remain incompletely understood.

Methods

This prespecified secondary analysis of a randomized controlled trial evaluated embolic lesion patterns following transradial cerebral angiography under different heparin strategies. Patients with postoperative DWI were included. Lesion patterns were characterized by multiplicity, laterality, size, and overall burden. Multivariable Poisson regression identified factors associated with DWI‐positive lesions and lesion distribution patterns.

Results

Among 456 patients with evaluable postoperative DWI, embolic lesions were detected in 77 (16.9%). Most lesions were small (<5 mm [62.3%]) and cortical (61.0%), whereas 29.9% had multiple lesions and 22.1% had bilateral involvement. Fazekas grade ≥2 (adjusted risk ratio [RR], 2.38 [95% CI, 1.60–3.53]; P <0.001) and longer procedure duration (adjusted RR, 1.05 [95% CI, 1.02–1.08] per minute; P <0.001) were significantly associated with DWI‐positive lesions. Heparin strategy was not associated with overall lesion incidence. However, heparinization combined with continuous heparinized saline flush was significantly associated with multiple lesions (adjusted RR, 1.52 [95% CI, 1.01–2.28]; P =0.044), bilateral involvement (adjusted RR, 1.21 [95% CI, 1.04–1.42]; P =0.015), and high lesion load (adjusted RR, 2.86 [95% CI, 1.02–8.01]; P =0.045).

Conclusions

Embolic lesions after transradial cerebral angiography show heterogeneous distribution patterns beyond incidence alone. Characterization of lesion multiplicity, laterality, and burden provides a more nuanced assessment of embolic injury. Continuous pressurized heparinized saline flush is associated with more diffuse lesion patterns, highlighting procedural and technical influences on embolic risk.

Registration

URL: chictr.org.cn ; Unique Identifier: ChiCTR2400080902.

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