Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging.
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).
Ghanem
Alexander
A
Department of Medicine/Cardiology, University of Bonn, Bonn, Germany. ghanem@uni-bonn.de
Müller
Andreas
A
Nähle
Claas P
CP
Kocurek
Justine
J
Werner
Nikos
N
Hammerstingl
Christoph
C
Schild
Hans H
HH
Schwab
Jörg O
JO
Mellert
Fritz
F
Fimmers
Rolf
R
Nickenig
Georg
G
Thomas
Daniel
D
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