Clinical Research
Invasive and Interventional Cardiology
Risk and Fate of Cerebral Embolism After Transfemoral Aortic Valve Implantation: A Prospective Pilot Study With Diffusion-Weighted Magnetic Resonance Imaging

https://doi.org/10.1016/j.jacc.2009.12.026Get rights and content
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Objectives

The aim of this study was prospective investigation of silent and clinically apparent cerebral embolic events and neurological impairment after transfemoral aortic valve implantation (TAVI).

Background

TAVI is a novel therapeutic approach for multimorbid patients with severe aortic stenosis. We investigated peri-interventional cerebral embolism with diffusion-weighted magnetic resonance imaging (DW-MRI) and its relationship to clinical and serologic parameters of brain injury.

Methods

Cerebral DW-MRI was performed before, directly, and 3 months after TAVI with the current third-generation self-expanding CoreValve (Medtronic, Minneapolis, Minnesota) prosthesis. At the timepoints of the serial MRI studies, focal neurological impairment was assessed according to the National Institutes of Health Stroke Scale (NIHSS), and serum concentration of neuron-specific enolase (NSE), a marker of the volume of brain tissue involved in an ischemic event, were determined.

Results

Thirty patients were enrolled; 22 completed the imaging protocol. Three patients (10%) had new neurological findings after TAVI, of whom only 1 (3.6%) had a permanent neurological impairment. Of the 22 TAVI patients with complete imaging data, 16 (72.7%) had 75 new cerebral lesions after TAVI presumed to be embolic. The NIHSS and NSE were not correlated with DW-MRI lesions.

Conclusions

The incidence of clinically silent peri-interventional cerebral embolic lesions after TAVI is high. However, in this cohort of 30 patients, the incidence of persistent neurological impairment was low. (Incidence and Severity of Silent and Apparent Cerebral Embolism After Conventional and Minimal-invasive Transfemoral Aortic Valve Replacement; NCT00883285)

Key Words

aortic stenosis
CoreValve
embolism
percutaneous
stroke
valvuloplasty

Abbreviations and Acronyms

DW-MRI
diffusion-weighted magnetic resonance imaging
E1
before transfemoral aortic valve implantation
E2
within 3 days of transfemoral aortic valve implantation
E3
3 months after transfemoral aortic valve implantation
NIHSS
National Institutes of Health Stroke Scale
NSE
neuron-specific enolase
TAVI
transfemoral aortic valve implantation

Cited by (0)

Drs. Ghanem and Müller contributed equally to this work.