Abstract 4293: Silent and Apparent Cerebral Embolism After Interventional Aortic Valve Replacement
Background and Purpose - Transfemoral aortic valve replacement (AVR) is a novel therapeutic approach for old and multimorbid patients with severe, symptomatic aortic stenosis. In this study, we prospectively evaluated peri-interventional neurological deficit, serologic markers of ischemic injury and cranial magnetic resonance imaging (MRI) to assess risk and fate of ischemic cerebral embolism after AVR.
Methods - NIH stroke score (NIHSS) was assessed, serum concentrations of lactate and neuron-specific enolase (NSE) were measured and MRI studies were determined one day before as well as two days and three months after AVR. Abundance, localisation and volume of embolic lesions were quantified with T2- and diffusion-weighted MRI (DWI).
Results - Sixteen consecutive patients undergoing AVR completed the study protocol. Baseline characteristics demonstrated high rate of comorbidities [age: 80.4±5.9 years, STS-score: 20.6±8.1 %, CHADS-Score: 2.7±1.2, prior stroke: 25 %]. Lactate and NSE were not significantly increased after AVR. One patient developed mild (6 %, NIHSS: 4) and one patient developed severe post-interventional neurological deficit (6 %, NIHSS: 16). New peri-interventional DWI lesions were present in 14 patients (87 %, range: 1–22 lesions per patient). 13 % of the lesions were cortical. 57 % of the lesions were detected in the posterior perfusion bed. 34 % of the lesions were located in the cerebellum. The incidence of new DWI lesions was not associated with comorbidities (STS-score) or known risk factors of cardiac embolism (CHADS-score).
Conclusions - The incidence of clinically silent cerebral embolic lesions after AVR is high. MRI could serve as surrogate parameter for neuroprotective interventions in the emerging field of AVR.