title: Silent ischemic brain lesions after transcatheter aortic valve replacement: lesion distribution and predictors.
abstract: OBJECTIVE
  Silent ischemic brain lesions and ischemic stroke are known complications of transcatheter aortic valve replacement (TAVR). We aimed to investigate the occurrence and distribution of TAVR-related silent ischemic brain lesions using diffusion-weighted magnetic resonance imaging (DWI).
  
  
  METHODS
  Consecutive patients with severe aortic valve stenosis treated with TAVR underwent cerebral DWI within 5 days after the index procedure. DWI scans were analyzed for the occurrence and distribution of new ischemic lesions post-TAVR.
  
  
  RESULTS
  Forty-two patients were enrolled in this study. After TAVR, a total of 276 new cerebral ischemic lesions were detected in 38 (90 %) patients, with a median of 4.5 (interquartile range 2.0-7.0) lesions per patient. A total of 129 (47 %) lesions were detected in the cortical regions, 97 (35 %) in the subcortical regions, and 50 (18 %) in the cerebellum or brainstem. The median lesion volume was 20.2 µl (10.0, 42.7) and the total ischemic lesion volume was 132.3 µl (42.8, 336.9). The new ischemic brain lesions were clinically silent in 37 (97 %) patients; the other patient had a transient ischemic attack. Age (B = 0.528, p = 0.015), hyperlipidaemia (B = 5.809, p = 0.028) and post-dilatation of the implanted prosthesis (B = 7.196, p = 0.029) were independently associated with the number of post-TAVR cerebral DWI lesions. In addition, peak transaortic gradient was independently associated with post-procedural total infarct volume.
  
  
  CONCLUSIONS
  Clinically silent cerebral infarcts occurred in 90 % of patients following TAVR, most of which were small (<20 μl) and located in the cortical regions of the cerebral hemispheres. An independent association was found between age, hyperlipidaemia and balloon post-dilatation and the number of post-TAVR ischemic brain lesions. Only peak transaortic gradient was independently associated with post-procedural total infarct volume.
authors.affiliation: Department of Cardiology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, Room E. 05.2308, 3584 CX, Utrecht, The Netherlands, mariasamim@gmail.com.
authors.forename: Mariam
authors.initials: M
authors.lastname: Samim
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendrikse
authors.forename: H Bart
authors.initials: HB
authors.lastname: van der Worp
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Freek
authors.initials: F
authors.lastname: Nijhoff
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Pieter R
authors.initials: PR
authors.lastname: Stella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*