title: Cerebral embolization during percutaneous valve implantation does not occur during balloon inflation valvuloplasty: prospective diffusion-weighted brain MRI study.
abstract: OBJECTIVE
  The study aim was to define the timing of cerebral embolization events during transcatheter aortic valve implantation (TAVI), and to determine if events were more closely associated with valve implantation or with balloon inflation.
  
  
  METHODS
  Between January 2008 and November 2011, a total of 114 patients underwent TAVI at the author's institution. Of these patients, 44 had previously undergone imaging before and after TAVI, and were included in the study (26 transfemoral (TF); 18 transapical (TA)). Eleven patients who had only balloon valvuloplasty (BV) during the same period were included, as were 22 patients who had open aortic valve replacement (AVR), as controls. All 77 patients underwent neurological examination, and all had cerebral MRIs before and after their procedures.
  
  
  RESULTS
  Fifty of the 77 patients who underwent postprocedural MRI had new cerebral lesions, as follows: 24/26 (92%) in TF patients; 17/18 (94%) in TA patients; 3/11 (27%) in BV patients; and 6/22 (27%) in AVR patients (TF and TA versus BV and AVR, p < 0.0001). The mean number and volume of embolic lesions per patient were respectively 5.4/438 mm3 for TF, 11.6/3414 mm3 for TA, 0.7/46 mm3 for BV, and 0.4/48 mm3 for AVR (TF versus TA and BV versus AVR, p = NS; TF and TA versus BV and AVR, p < 0.0001). No association was found between either the EuroSCORE or patient age and the number of events.
  
  
  CONCLUSIONS
  In the present study, an incidence of silent cerebral embolic lesions after TAVI was identified which was significantly higher than that for BV or AVR. This indicated an association of embolism with valve implantation rather than with balloon inflation.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Saint-Luc, Brussels, Belgium. parla.astarci@uclouvain.be
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.forename: Joel
authors.initials: J
authors.lastname: Price
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: William
authors.initials: W
authors.lastname: D'Hoore
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.forename: Gébrine
authors.initials: G
authors.lastname: Elkhoury
authors.forename: Cécile
authors.initials: C
authors.lastname: Grandin
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology*; D008297:Male; D011446:Prospective Studies