Evolution, Predictors, and Neurocognitive Effects of Silent Cerebral Embolism During Transcatheter Aortic Valve Replacement
| Autor: | Claudia Fiorina, Gianmichele Migaleddu, Marco L. Rossi, Bernhard Reimers, A. Sonia Petronio, Ciro Indolfi, Carmen Spaccarotella, Giovanni Orlandi, Alaide Chieffo, Riccardo Liga, Mirco Cosottini, Marco De Carlo, Francesco De Caro, Melania Scatturin |
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| Přispěvatelé: | De Carlo, M., Liga, R., Migaleddu, G., Scatturin, M., Spaccarotella, C., Fiorina, C., Orlandi, G., De Caro, F., Rossi, M. L., Chieffo, A., Indolfi, C., Reimers, B., Cosottini, M., Petronio, A. S. |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
neurocognitive function
Male Time Factors Databases Factual medicine.medical_treatment 030204 cardiovascular system & hematology Neuropsychological Tests 0302 clinical medicine Cognition Valve replacement Risk Factors 80 and over 030212 general & internal medicine Prospective Studies Aged 80 and over Neurocognitive Disorder medicine.diagnostic_test silent cerebral ischemic lesions Magnetic Resonance Imaging silent cerebral ischemic lesion Natural history medicine.anatomical_structure Treatment Outcome Intracranial Embolism Italy Cardiology cerebral magnetic resonance imaging transcatheter aortic valve replacement Aged Aortic Valve Stenosis Asymptomatic Diseases Female Humans Neurocognitive Disorders Risk Assessment Transcatheter Aortic Valve Replacement Neuropsychological Test Cardiology and Cardiovascular Medicine Human medicine.medical_specialty Transcatheter aortic Time Factor White matter 03 medical and health sciences Databases Cerebral embolism Internal medicine medicine Clinical significance Factual Asymptomatic Disease business.industry Risk Factor Magnetic resonance imaging Aortic Valve Stenosi Prospective Studie business Neurocognitive |
| Popis: | Objectives The aim of this study was to assess the characteristics, predictors, evolution, and neurocognitive effects of silent cerebral ischemic lesions (SCILs). Background Most patients undergoing transcatheter aortic valve replacement (TAVR) develop SCILs detectable on magnetic resonance imaging (MRI). The natural history and clinical relevance of SCILs are not well established. Methods Cerebral MRI was performed within 7 days before TAVR to assess baseline status and age-related white matter change score. MRI was repeated post-operatively to assess the occurrence, location, number, and dimensions of SCILs. Patients developing SCILs underwent a third MRI examination at 3- to 5-month follow-up. A neurocognitive evaluation was performed before TAVR, at discharge, and at 3-month follow-up. Results Of the 117 patients enrolled, 96 underwent post-procedural MRI; SCILs were observed in 76% of patients, distributed in all vascular territories, with a median number of 2 lesions, a median diameter of 4.5 mm, and a median total volume of 140 mm3. Independent predictors of SCIL occurrence were higher baseline age-related white matter change score and the use of self-expanding or mechanically expanded bioprostheses. Among 47 patients who underwent follow-up MRI, only 26.7% of post-procedural SCILs evolved into gliotic scar. SCIL occurrence was associated with a more pronounced transient neurocognitive decline early after TAVR and with lower recovery at follow-up. Conclusions SCILs occur in the vast majority of patients undergoing TAVR and are predicted by more diffuse white matter damage at baseline and by the use of non-balloon-expandable prostheses. Although most SCILs disappear within months, their occurrence has a limited but significant impact on neurocognitive function. |
| Databáze: | OpenAIRE |
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