Cerebral Embolism Following Transcatheter Aortic Valve Implantation

Rodés‐Cabau, Josep; Dumont, Éric; Boone, Robert H.; Larose, Éric; Bagur, Rodrigo; Gurvitch, Ronen; Bédard, François; Doyle, D. John; Larochellière, Robert De; Jayasuria, Cleonie; Villeneuve, Jacques; Marrero, Alier; Côté, Mélanie; Pîbarot, Philippe; Webb, John G.

doi:10.1016/j.jacc.2010.07.036

Cited by 271 publications

(176 citation statements)

References 43 publications

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“…42 devices and approaches ( Figure 5). 35,[43][44][45][46][47] Analysis of diffusionweighted (DW) MRI studies performed pre-and post-TAVI includes a cumulative total of only 222 patients. TA-TAVI with ES was performed in 68 of these patients, with 52 (76.5%) having newly identified ischemic lesions on MRI postprocedure, and 2 (2.9%) with clinically manifest CVEs.…”

Section: Diffusion-weighted Mrimentioning

confidence: 99%

“…43 Although early studies using DW-MRI supported this, 43,47 the association has not been confirmed by more recent studies. 35,[44][45][46] Similarly, although findings have been inconsistent, there is the suggestion of increased vulnerability of the anterior circulation in comparison with the posterior circulation, with a preponderance for new ischemic lesions in the middle cerebral artery territories. 35,44,45 Not surprisingly, the incidence and volume of preoperative silent ischemic lesions (present in 70% of patients) predicted the occurrence of new postoperative lesions.…”

Section: Diffusion-weighted Mrimentioning

confidence: 99%

“…35,[44][45][46] Similarly, although findings have been inconsistent, there is the suggestion of increased vulnerability of the anterior circulation in comparison with the posterior circulation, with a preponderance for new ischemic lesions in the middle cerebral artery territories. 35,44,45 Not surprisingly, the incidence and volume of preoperative silent ischemic lesions (present in 70% of patients) predicted the occurrence of new postoperative lesions. 49 Individuals with new neurological signs demonstrated a significantly higher number (26 versus 2.7±3, P=0.004) and volume (11.9±6 mL versus 1.1±1.1 mL, P=0.007) of new cerebral infarcts.…”

Section: Diffusion-weighted Mrimentioning

confidence: 99%

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Characterization of Neurological Injury in Transcatheter Aortic Valve Implantation

et al. 2014

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Section: Diffusion-weighted Mrimentioning

confidence: 99%

Section: Diffusion-weighted Mrimentioning

confidence: 99%

Section: Diffusion-weighted Mrimentioning

confidence: 99%

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Characterization of Neurological Injury in Transcatheter Aortic Valve Implantation

et al. 2014

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“…Furthermore, the average 30-day mortality in TAVR patients with post-procedural stroke was more than 3.5-fold higher than in non-stroke patients (25.5 vs. 6.9) [3]. In addition to the clinically apparent ischemic brain lesions, several cerebral magnetic resonance imaging studies have shown a very high (58-91 %) incidence of new ischemic lesions after TAVR, regardless of the transcatheter valve type and approach (Table 1) [4][5][6][7][8][9]. These small, usually asymptomatic, DWI lesions are most probably caused by micro-embolic particles arising during the valve implantation procedure.…”

Section: Introductionmentioning

confidence: 99%

Silent ischemic brain lesions after transcatheter aortic valve replacement: lesion distribution and predictors

et al. 2015

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Aims Silent ischemic brain lesions and ischemic stroke are known complications of transcatheter aortic valve replacement (TAVR). We aimed to investigate the occurrence and distribution of TAVR-related silent ischemic brain lesions using diffusion-weighted magnetic resonance imaging (DWI). Methods Consecutive patients with severe aortic valve stenosis treated with TAVR underwent cerebral DWI within 5 days after the index procedure. DWI scans were analyzed for the occurrence and distribution of new ischemic lesions post-TAVR. Results Forty-two patients were enrolled in this study. After TAVR, a total of 276 new cerebral ischemic lesions were detected in 38 (90 %) patients, with a median of 4.5 (interquartile range 2.0-7.0) lesions per patient. A total of 129 (47 %) lesions were detected in the cortical regions, 97 (35 %) in the subcortical regions, and 50 (18 %) in the cerebellum or brainstem. The median lesion volume was 20.2 ll (10.0, 42.7) and the total ischemic lesion volume was 132.3 ll (42.8, 336.9). The new ischemic brain lesions were clinically silent in 37 (97 %) patients; the other patient had a transient ischemic attack. Age (B = 0.528, p = 0.015), hyperlipidaemia (B = 5.809, p = 0.028) and post-dilatation of the implanted prosthesis (B = 7.196, p = 0.029) were independently associated with the number of post-TAVR cerebral DWI lesions. In addition, peak transaortic gradient was independently associated with post-procedural total infarct volume. Conclusion Clinically silent cerebral infarcts occurred in 90 % of patients following TAVR, most of which were small (\20 ll) and located in the cortical regions of the cerebral hemispheres. An independent association was found between age, hyperlipidaemia and balloon postdilatation and the number of post-TAVR ischemic brain lesions. Only peak transaortic gradient was independently associated with post-procedural total infarct volume.

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“…9,11 Rodés-Cabau found no difference with cerebral MRI when transapical and transarterial approaches were compared. 4,8,12 However, 2 recent meta-analyses did suggest a lower stroke risk with transapical TAVI. Comparing transapical and transarterial access with the balloon expandable SAPIEN valve Eggebrecht found a neurological event rate (stroke/transient ischemic event) of 2.7% versus 4.2%.…”

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confidence: 99%

Cerebral Embolization During Transcatheter Aortic Valve Implantation

Webb

Barbanti

2012

Circulation

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T he recent success of transcatheter aortic valve implantation (TAVI) has been associated with a heightened awareness of the potential risks, particularly stroke. Recent meta-analyses report 30-day stroke rates of 3% to 4%, 1,2 and diffusion-weighted MRI studies have revealed new, clinically silent, cerebral lesions in 68% to 84% of patients undergoing TAVI. [3][4][5] Although the majority of patients undergoing TAVI benefit greatly in terms of quality of life and functional status, concerns about neurological disability remain.Transcranial Doppler (TCD) has been extremely helpful in clarifying the central role of cerebral embolism as the major cause of intraprocedural stroke. As Kahlert et al 4 report, cerebral microembolism occurs in essentially all patients undergoing TAVI. High-intensity transient signals, largely reflecting particulate emboli, are routinely detected during many invasive cardiac procedures. Nevertheless, it has been difficult to demonstrate that high-intensity transient signals correlate directly with stroke, and attempts to correlate high-intensity transient signals with biomarkers of neuronal injury have been inconsistent. 3,6 Importantly, TCD has provided considerable information about the relative contributions of the various elements of the TAVI procedure to the risk of cerebral embolization.

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Cerebral Embolism Following Transcatheter Aortic Valve Implantation

Cited by 271 publications

References 43 publications

Characterization of Neurological Injury in Transcatheter Aortic Valve Implantation

Characterization of Neurological Injury in Transcatheter Aortic Valve Implantation

Silent ischemic brain lesions after transcatheter aortic valve replacement: lesion distribution and predictors

Cerebral Embolization During Transcatheter Aortic Valve Implantation

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