Finding new cerebral ischemic imaging after transcatheter aortic valve replacement (TAVR) is almost the rule, especially for self-expandable valves. These images might disappear over the months but, unfortunately, they are associated to small but significative cognitive deterioration.
Most patients undergoing TAVR develop silent cerebral ischemic lesions (SCILs) that show in magnetic resonance imaging (MRI). The natural history of this images and their potential clinical implications were not well established in the literature.
This study included 117 patients with baseline MRI within 7 days before TAVR and age-related white matter change score.
After procedure, a new MRI was done to assess occurrence, localization, number and dimension of the new ischemic lesions. Patients with new lesions repeated the MRI at 3 to 5 months followup.
In addition to MRIs, neurocognitive tests were carried out prior procedure, at discharge and at 3-month followup.
There were new ischemic lesions in 76% of patients, distributed across all territories: a median number of 2, median diameter 4.5 mm and median total volume 140 mm³.
Independent predictors of these images were greater baseline age-related white matter deterioration and the use of self-expandable valves.
Read also: Post TAVR Acute Coronary Syndrome: Frequency and Potential Damage.
The third MRI showed only 26.7% of patients evolved with a post procedure gliotic scar in lieu of ischemic lesions.
After procedure, there was transient neurocognitive deterioration in all patients, but this was far more pronounced in patients with new ischemic lesions. Also, recovery was slower when there were new ischemic lesions.
Conclusion
Silent ischemic lesions were observed in most patients undergoing TAVR. Most of these lesions can disappear over time, but they have significant cognitive impact.
Original Title: Evolution, Predictors, and Neurocognitive Effects of Silent Cerebral Embolism During Transcatheter Aortic Valve Replacement.
Reference: Marco De Carlo et al. J Am Coll Cardiol Intv 2020, article in press. https://doi.org/10.1016/j.jcin.2020.03.004.
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