Heparinized saline flush associated with higher risk of multiple and bilateral embolic lesionsHeparin flush methods linked to more complex brain lesion patterns

Journal of the American Heart Association Published August 6, 2026 Study authors: Liu Chenchen, Li Peixin, Fan Tiancen, Deng Gang, Wang Yihui, Ao Donghui, Huang Hao, Zhang Yi, Xie Yi… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Note that heparinized saline flush is associated with higher rates of multiple and bilateral embolic lesions.

This secondary analysis of a randomized controlled trial included 456 patients undergoing transradial cerebral angiography with evaluable postoperative DWI. The study evaluated various heparin strategies, including the use of continuous heparinized saline flush, and their impact on embolic lesion patterns such as multiplicity, laterality, size, and overall burden.

Overall embolic lesion detection was observed in 77 patients (16.9%). Most identified lesions were small (62.3%) and located in the cortex (61.0%). While the specific heparin strategy used did not show a significant association with the overall incidence of lesions, the use of a heparinized saline flush was significantly associated with more complex patterns. Specifically, heparinized saline flush was associated with multiple lesions (RR 1.52; 95% CI, 1.01-2.28; p = 0.044), bilateral involvement (RR 1.21; 95% CI, 1.04-1.42; p = 0.015), and high lesion load (RR 2.86; 95% CI, 1.02-8.01; p = 0.045).

Other significant associations included Fazekas grade \u22652 (RR 2.38; 95% CI, 1.60-3.53; p < 0.001) and procedure duration (RR 1.05 per minute; 95% CI, 1.02-1.08; p < 0.001) with DWI-positive lesions. As a secondary analysis of an RCT, these findings indicate that while heparinized saline flush does not change the total number of lesions, it is associated with more diffuse lesion patterns.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in understanding how specific perfusion techniques during neurointerventional procedures affect embolic distribution. While previous coverage noted that prehospital unfractionated heparin bolus improved TIMI flow in STEMI without increasing bleeding risk and systemic heparinization reduces early patency loss in AVF or graft placement, this study specifically highlights how the choice of saline flush during cerebral angiography may correlate with more extensive lesion patterns (multiple, bilateral, high load).

When doctors perform a procedure called transradial cerebral angiography, they use heparin—a medicine that prevents blood from clotting. Because of the risk of clots, choosing the right way to flush the system with heparinized saline is vital for protecting the brain.

A secondary analysis of 456 patients revealed some specific patterns in how brain lesions appear after this procedure. While the overall number of lesions did not change based on the type of heparin used, a specific method called a continuous heparinized saline flush was linked to more complex issues. Specifically, patients who received this flush were more likely to have multiple lesions, involvement on both sides of the brain, and a higher total load of damage.

It is important to note that these findings come from a secondary analysis of an existing trial. While the data shows a clear link between certain flushing methods and more widespread lesion patterns, it does not prove one method is definitively better than another for every patient. These results help doctors understand how different techniques might affect the way brain tissue reacts during treatment.

What this means for you:

A specific heparin flush technique was linked to more frequent multiple and bilateral brain lesions.

Common questions

What did the study find about different heparin strategies?

The researchers looked at 456 patients. They found that while the overall number of lesions was not linked to the specific heparin strategy used, a continuous heparinized saline flush was significantly associated with more complex patterns, such as multiple lesions and involvement on both sides of the brain.

What are these 'lesions' mentioned in the study?

Lesions are areas of damage to the brain tissue. In this study, 77 out of 456 patients had detectable lesions. Most of these were small (under 5mm) and located in the outer layer of the brain, known as the cortex.

How does procedure length affect the results?

The study found a significant link between how long the procedure lasted and the presence of lesions. For every extra minute the procedure took, there was a slight increase in the risk of finding a lesion on the scan.

Study Details

Study typeRct

Sample sizen = 456

EvidenceLevel 2

PublishedAug 2026

PMID42535567

View Original Abstract ↓

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]; <0.001) and longer procedure duration (adjusted RR, 1.05 [95% CI, 1.02-1.08] per minute; <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]; =0.044), bilateral involvement (adjusted RR, 1.21 [95% CI, 1.04-1.42]; =0.015), and high lesion load (adjusted RR, 2.86 [95% CI, 1.02-8.01]; =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.

Heparinized saline flush associated with higher risk of multiple and bilateral embolic lesionsHeparin flush methods linked to more complex brain lesion patterns

How this fits prior evidence

Common questions

Study Details

Machine Learning Model Performance for Predicting Contrast Induced Nephropathy in Coronary Interventions

Machine learning models help predict kidney damage during heart procedures

Clinical research that matters. Delivered to your inbox.

Heparinized saline flush associated with higher risk of multiple and bilateral embolic lesionsHeparin flush methods linked to more complex brain lesion patterns

How this fits prior evidence

Common questions

More on heparin

Study Details

Machine Learning Model Performance for Predicting Contrast Induced Nephropathy in Coronary Interventions

Machine learning models help predict kidney damage during heart procedures

Clinical research that matters. Delivered to your inbox.

Related in Radiology & Imaging

From Other Specialties