Abstract 15875: Magnetic Resonance Imaging Detects Asymptomatic Microembolic Cerebral Lesions after Transcatheter Aortic Valve Implantation
Purpose: Transcatheter aortic valve implantation (TAVI) is an emerging alternative treatment option for patients with symptomatic severe aortic stenosis (AS) and high risk for operative valve replacement. However, stroke can be a catastrophic complication of TAVI. Stroke has been reported to occur in up to 6.3% of patients undergoing TAVI. This study aimed to assess frequency and extent of subclinical microembolic cerebral lesions after TAVI.
Patients and Methods: In our institution, 66 patients (20 male, 46 female; mean age 81 ± 5 years) with symptomatic severe AS underwent TAVI between July 2008 and April 2010. The third-generation CoreValve prosthesis was implanted via transfemoral access using the 18 French delivery catheter system. 57 patients were scheduled for cerebral diffusion-weighted magnetic resonance imaging (DW MRI) two days before and up to six days after TAVI. Nine patients were not eligible due to pacemaker implantation prior to enrolment. 38 patients underwent both pre- and postinterventional DW MRI, while 19 patients could not undergo postinterventional MRI and had to be excluded from analysis (need for permanent pacemaker implantation, n=5; critical status, n=7; MRI not available, n=6; deceased, n=1).
Results: Thorough physical examination did not reveal any changes in neurological status after TAVI. However, comparison of pre- and postinterventional DW MRI showed that 34 of 38 patients (89.5%) had newly acquired bright lesions (p <0.001) in accordance with subclinical cerebral embolisation: class I (1–3 new bright lesions), n=14 (36.8%); class II (4–7 new bright lesions), n=11 (28.9%); class III (≥8 new bright lesions or cortical infarction), n=9 (23.7%). Only in four patients (10.5%) there was no evidence for any newly acquired bright lesion (class 0).
Conclusions: TAVI with the self-expanding CoreValve bioprosthesis is an emerging alternative treatment option for high-risk patients with symptomatic severe AS. Albeit risk of stroke is low, the vast majority of patients show newly acquired bright lesions in DW MRI compatible with subclinical cerebral embolisation. Embolic protection devices along with improved techniques and less traumatic catheters might contribute to minimize cerebral microembolisation and even stroke.
- Aortic valve stenosis
- Interventional cardiology
- Magnetic resonance imaging
- Valvular heart disease
- © 2010 by American Heart Association, Inc.