title: Clinical implications for diffusion-weighted MRI brain lesions associated with transcatheter aortic valve replacement.
abstract: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with aortic stenosis deemed high or extreme surgical risk candidates. Despite improved survival and quality of life following the procedure, TAVR is not without its complications. Stroke is a major source of morbidity and mortality in patients undergoing the procedure, with rates similar to and often higher than those associated with surgery. Most studies show a consistent link between TAVR and embolic lesions visualized on diffusion-weighted magnetic resonance imaging. The question of whether these lesions lead to long-term cognitive consequences remains open, but given the large literature on silent strokes and cognition, this association is probable. Initial studies implementing cerebral embolic protection devices in TAVR have yielded promising results with decreased neurological complications and appearance of new lesions on imaging. In this article, we will review the evidence linking silent stroke with cognitive decline, and potential therapeutic options to prevent stroke related to TAVR, including cerebral protection devices currently under investigation.
authors: Yale University School of Medicine and Yale Cardiovascular Research Group, New Haven, Connecticut.
authors: Stephanie M
authors: SM
authors: Meller
authors: Andreas
authors: A
authors: Baumbach
authors: Adam M
authors: AM
authors: Brickman
authors: Alexandra J
authors: AJ
authors: Lansky
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control; D038524:Diffusion Magnetic Resonance Imaging; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000523:psychology
keywords: DW-MRI; TAVR; cerebral embolism