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Diffusion-Weighted MRI Determined Cerebral Embolic Infarction Following Transcatheter Aortic Valve Implantation: Assessment of Predictive Risk Factors and the Relationship to Subsequent Health Status
Study Questions:
What are the frequency and predictors of cerebral infarction in patients undergoing transcatheter aortic valve implantation (TAVI), and its impact on patient health-related quality of life (HRQoL)?
Methods:
The authors performed cerebral diffusion-weighted MRI on 31 patients before and after CoreValve TAVI. HRQoL was assessed at baseline and at 30 days by SF-12v2 and EQ5D questionnaires.
Results:
New cerebral infarction on diffusion-weighted imaging was seen in 24/31 patients (77%), and stroke in 2 patients (6%). There were a total of 131 new infarcts that were distributed equally between the cerebral hemispheres (left 53%, right 47%), and in multiple territories (anterior 7%, middle 59%, posterior 14%, and vertebrobasilar 20%). The average number of infarcts per patient was 4.2 and the median was 2. Stroke was associated with a greater number and volume of cerebral infarcts. Age, severity of aortic atheroma, and catheterization time were independent predictors of the number of new cerebral infarcts. HRQoL as assessed by SF-12v2 physical component summary increased significantly (32.4 vs. 36.5; p = 0.03), with no significant change in mental component summary (43.56 vs. 43.16; p = 0.85). The EQ5D score (0.56 vs. 0.59; p = 0.70) and Visual Analogue Scale (54.2 vs. 58.2; p = 0.43) showed no significant change.
Conclusions:
The authors concluded that among patients undergoing TAVI, silent cerebral infarction is common and is associated with increased age and severity of arch atheroma.
Perspective:
Stroke remains one of the most important complications of TAVI. In this small study, silent cerebral infarction was seen in most patients, and this, combined with the relatively high frequency of clinical stroke observed in other studies, invokes the need for evaluation of embolization protection devices to improve procedural safety.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Magnetic Resonance Imaging
Keywords: Infarction, Stroke, Plaque, Atherosclerotic, Cerebral Infarction, Catheterization, Risk Factors, Angioplasty, Balloon, Coronary, Pain Measurement, Diffusion Magnetic Resonance Imaging
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