Comparison of silent cerebral i̇schemia between right and left transradial percutaneous coronary i̇ntervention

INTRODUCTION: Silent cerebral ischemia (SCI) is defined as a condition that can be detected by biochemical markers or cranial imaging methods, but does not produce clinical symptom. Studies show that the frequency of SCI increases after many cardiological procedures, especially percutaneous coronary interventions (PCI). This study aims both to compare the frequency of SCI in PCIs performed with right transradial access and left transradial access and to evaluate the influencing factors. TOOLS AND METHODS: Patients who underwent PCI with transradial access were examined in the study. The patients were divided into two groups as right radial and left radial. Out of a total of 197 patients included in the study, PCI was performed consecutively in 99 patients with right radial Access and 98 patients with left radial access. Neuron Specific Enolase (NSE) values were measured and recorded before and 18 hours after the procedure. Higher than 20 ng/dl post-procedure NSE level was defined as SCI. RESULTS: The majority of the patients were male (%69,5). The mean age was 62 years. The number of catheters used (p<0.001) and the total number of materials (p=0.012) were statistically less in the right radial group. In addition, the presence of subclavian tortuosity and the amount of contrast used tended to be greater in the right radial group. SCI occurred in 60 of the 197 patients. NSE elevation was observed at a rate of %37.4 (n=37) in the right radial group and %23.5 (n=23) in the left radial group (p=0.032). Patients with SCI had higher rates of smoking (p=0.043), presence of subclavian tortuosity (p=0.027) and HbA1c (p=0.031). In the multivariate logistic regression analysis, level of EF (ejection fraction) (OR:0.954 %95 CI 0.910-0.997, p=0.038), subclavian thortiosity (OR:0.396 %95 GA 0.154-0.948 p=0.037) and smoking (OR:2.062 %95 GA 1.071-3.970, p=0.030) were observed as independent variables of NSE elevation. DISCUSSION: SCI rates were higher in right radial PCIs than left radial PCIs. Smoking, low EF level, and presence of subclavian tortuosity were independent predictors of SSI in patients who underwent PCI. In addition, increased HbA1c elevation due to poor diabetes control were observed to increase the risk of SCI. Keywords: Coronary intervention, Neurone spesific enolase, Silent cerebral ischemia, Stroke, Transradial