title: Which is the correct management of patients with asymptomatic severe calcific aortic stenosis after symptomatic spontaneous calcium cerebral embolism?
abstract: Elective surgery cannot be recommended in every patient with asymptomatic severe aortic stenosis, and predictors identifying high-risk patients need to be identified. In guidelines we read that elective surgery, at the asymptomatic stage, can only be recommended in selected patients, at low operative risk (see guidelines of European Society of Cardiology and American Heart Association), but we have not read any reference to patients with severe calcific aortic stenosis after symptomatic spontaneous calcium cerebral embolism. Because cardioembolic stroke is associated with poor prognosis compared to other stroke subtypes, in patients with asymptomatic severe aortic stenosis and spontaneous calcific embolic stroke valve replacement appears to offer the best hope of avoiding a recidivation of stroke and should be considered in most cases. On the contrary, is it still correct to consider as asymptomatic patients with severe aortic stenosis and cerebral thromboembolism from a calcified aortic valve?
authors.affiliation: Department of Cardiology, Second University of Naples, Naples, Italy. natalefrancesco@hotmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Natale
authors.forename: Luigi
authors.initials: L
authors.lastname: Aronne
authors.forename: Maria
authors.initials: M
authors.lastname: Credendino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Siciliano
authors.forename: Filomena
authors.initials: F
authors.lastname: Allocca
authors.forename: Sara Hana
authors.initials: SH
authors.lastname: Weizs
authors.forename: Francesca
authors.initials: F
authors.lastname: Martone
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: di Marco
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.forename: Michele Adolfo
authors.initials: MA
authors.lastname: Tedesco
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D001024:Aortic Valve Stenosis / Q000209:etiology / Q000601:surgery*; D002114:Calcinosis / Q000209:etiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications*; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control