title: Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging.
abstract: OBJECTIVE
  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).
authors.affiliation: Department of Medicine/Cardiology, University of Bonn, Bonn, Germany. ghanem@uni-bonn.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Claas P
authors.initials: CP
authors.lastname: Nähle
authors.forename: Justine
authors.initials: J
authors.lastname: Kocurek
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Hans H
authors.initials: HH
authors.lastname: Schild
authors.forename: Jörg O
authors.initials: JO
authors.lastname: Schwab
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Daniel
authors.initials: D
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D010865:Pilot Projects; D012307:Risk Factors; D016896:Treatment Outcome