Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves
AimsTo evaluate the patient- and procedure-related predictors of transcatheter aortic-valve implantation (TAVI)-associated ischemic brain lesions and to assess the effect of silent cerebral ischemic lesions (SCIL) on neurocognitive function.Methods and resultsWe investigated 113 consecutive patients...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.951943/full |
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| author | Ferenc Imre Suhai Andrea Varga Bálint Szilveszter Milán Nagy-Vecsey Astrid Apor Anikó Ilona Nagy Anikó Ilona Nagy Márton Kolossváry Márton Kolossváry Júlia Karády Júlia Karády Andrea Bartykowszki Levente Molnár Ádám L. Jermendy Alexisz Panajotu Pál Maurovich-Horvat Béla Merkely |
| author_facet | Ferenc Imre Suhai Andrea Varga Bálint Szilveszter Milán Nagy-Vecsey Astrid Apor Anikó Ilona Nagy Anikó Ilona Nagy Márton Kolossváry Márton Kolossváry Júlia Karády Júlia Karády Andrea Bartykowszki Levente Molnár Ádám L. Jermendy Alexisz Panajotu Pál Maurovich-Horvat Béla Merkely |
| author_sort | Ferenc Imre Suhai |
| collection | DOAJ |
| description | AimsTo evaluate the patient- and procedure-related predictors of transcatheter aortic-valve implantation (TAVI)-associated ischemic brain lesions and to assess the effect of silent cerebral ischemic lesions (SCIL) on neurocognitive function.Methods and resultsWe investigated 113 consecutive patients with severe aortic stenosis who underwent brain magnetic resonance imaging (MRI) within a week following TAVI. To assess periprocedural cerebral ischemic lesions, diffusion-weighted MRI was utilized. We used multivariate linear regression to identify the independent predictors of TAVI-related ischemic lesion volume (ILV) and periprocedural stroke. Neurocognitive evaluation was performed before and following TAVI at 6-month and one-year follow-up. Following TAVI, a total of 944 new cerebral ischemic lesions were detected in 104 patients (92%). The median ILV was 257 μl (interquartile range [IQR]:97.1–718.8μl) with a median lesion number of 6/patient [IQR:2–10]. The majority of ischemic lesions were clinically silent (95%), while 5% of the lesions induced a stroke, which was confirmed by MRI. Predilatation (β = 1.13[95%CI:0.32–1.93], p = 0.01) and the number of valve positioning attempts during implantation (β = 0.28[95%CI:0.06–0.50], p = 0.02) increased the log-transformed total ILV. Predilatation (OR = 12.04[95%CI:1.46–99.07], p = 0.02) and alternative access routes (OR = 7.84[95%CI:1.01–61.07], p = 0.02) were associated with stroke after adjustments for comorbidities and periprocedural factors. The presence of SCILs were not associated with a change in neurocognitive function that remained stable during the one-year follow-up.ConclusionWhile periprocedural ischemic lesions are frequent, most of them are clinically silent and might not impact the patients' neurocognitive function. The number of valve positioning attempts, predilatation, and alternative access routes should be taken into consideration during TAVI to reduce the ILV and risk for stroke. |
| first_indexed | 2024-04-11T10:32:55Z |
| format | Article |
| id | doaj.art-c613e3494e664c58bc1e2da9839efe00 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T10:32:55Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-c613e3494e664c58bc1e2da9839efe002022-12-22T04:29:23ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-10-01910.3389/fcvm.2022.951943951943Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valvesFerenc Imre Suhai0Andrea Varga1Bálint Szilveszter2Milán Nagy-Vecsey3Astrid Apor4Anikó Ilona Nagy5Anikó Ilona Nagy6Márton Kolossváry7Márton Kolossváry8Júlia Karády9Júlia Karády10Andrea Bartykowszki11Levente Molnár12Ádám L. Jermendy13Alexisz Panajotu14Pál Maurovich-Horvat15Béla Merkely16Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryDepartment of Medicine, Karolinska Institute, Stockholm, SwedenCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United StatesCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United StatesCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryMedical Imaging Center, Semmelweis University, Budapest, HungaryCardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, HungaryAimsTo evaluate the patient- and procedure-related predictors of transcatheter aortic-valve implantation (TAVI)-associated ischemic brain lesions and to assess the effect of silent cerebral ischemic lesions (SCIL) on neurocognitive function.Methods and resultsWe investigated 113 consecutive patients with severe aortic stenosis who underwent brain magnetic resonance imaging (MRI) within a week following TAVI. To assess periprocedural cerebral ischemic lesions, diffusion-weighted MRI was utilized. We used multivariate linear regression to identify the independent predictors of TAVI-related ischemic lesion volume (ILV) and periprocedural stroke. Neurocognitive evaluation was performed before and following TAVI at 6-month and one-year follow-up. Following TAVI, a total of 944 new cerebral ischemic lesions were detected in 104 patients (92%). The median ILV was 257 μl (interquartile range [IQR]:97.1–718.8μl) with a median lesion number of 6/patient [IQR:2–10]. The majority of ischemic lesions were clinically silent (95%), while 5% of the lesions induced a stroke, which was confirmed by MRI. Predilatation (β = 1.13[95%CI:0.32–1.93], p = 0.01) and the number of valve positioning attempts during implantation (β = 0.28[95%CI:0.06–0.50], p = 0.02) increased the log-transformed total ILV. Predilatation (OR = 12.04[95%CI:1.46–99.07], p = 0.02) and alternative access routes (OR = 7.84[95%CI:1.01–61.07], p = 0.02) were associated with stroke after adjustments for comorbidities and periprocedural factors. The presence of SCILs were not associated with a change in neurocognitive function that remained stable during the one-year follow-up.ConclusionWhile periprocedural ischemic lesions are frequent, most of them are clinically silent and might not impact the patients' neurocognitive function. The number of valve positioning attempts, predilatation, and alternative access routes should be taken into consideration during TAVI to reduce the ILV and risk for stroke.https://www.frontiersin.org/articles/10.3389/fcvm.2022.951943/fullcerebral embolismtranscatheter aortic valve implantationcardiac CT angiography (CTA)strokemagnetic resonance imaging |
| spellingShingle | Ferenc Imre Suhai Andrea Varga Bálint Szilveszter Milán Nagy-Vecsey Astrid Apor Anikó Ilona Nagy Anikó Ilona Nagy Márton Kolossváry Márton Kolossváry Júlia Karády Júlia Karády Andrea Bartykowszki Levente Molnár Ádám L. Jermendy Alexisz Panajotu Pál Maurovich-Horvat Béla Merkely Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves Frontiers in Cardiovascular Medicine cerebral embolism transcatheter aortic valve implantation cardiac CT angiography (CTA) stroke magnetic resonance imaging |
| title | Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves |
| title_full | Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves |
| title_fullStr | Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves |
| title_full_unstemmed | Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves |
| title_short | Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves |
| title_sort | predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self expanding valves |
| topic | cerebral embolism transcatheter aortic valve implantation cardiac CT angiography (CTA) stroke magnetic resonance imaging |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.951943/full |
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