Topographical distribution of perioperative cerebral infarction associated with transcatheter aortic valve implantation
| Autor: | Adrian G. Barnett, David Platts, Allan J. Wesley, John F. Fraser, W. Strugnell, Andrew Wong, Darren L. Walters, Jonathon P. Fanning |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty 030204 cardiovascular system & hematology Embolic Protection Devices Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Postoperative Complications Interquartile range Internal medicine medicine Humans Intraoperative Complications Aged Aged 80 and over medicine.diagnostic_test business.industry Cerebral infarction Incidence (epidemiology) Australia Brain Magnetic resonance imaging EuroSCORE Perioperative Aortic Valve Stenosis Cerebral Infarction medicine.disease Magnetic Resonance Imaging Intracranial Embolism Cardiology Female Topographical distribution Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | American heart journal. 197 |
| ISSN: | 1097-6744 |
| Popis: | Background Transcatheter aortic valve implantation (TAVI) is associated with a high incidence of cerebrovascular injury. As these injuries are thought to be primarily embolic, neuroprotection strategies have focused on embolic protection devices. However, the topographical distribution of cerebral emboli and how this impacts on the effectiveness of these devices have not been thoroughly assessed. Here, we evaluated the anatomical characteristics of magnetic resonance imaging (MRI)–defined cerebral ischemic lesions occurring secondary to TAVI to enhance our understanding of the distribution of cardioembolic phenomena. Methods Forty patients undergoing transfemoral TAVI with an Edwards SAPIEN-XT valve under general anesthesia were enrolled prospectively in this observational study. Participants underwent brain MRI preprocedure, and 3 ± 1 days and 6 ± 1 months postprocedure. Results Mean ± SD participant age was 82 ± 7 years. Patients had an intermediate to high surgical risk, with a mean Society of Thoracic Surgeons score of 6.3 ± 3.5 and EuroSCORE of 18.1 ± 10.6. Post-TAVI, there were no clinically apparent cerebrovascular events, but MRI assessments identified 83 new lesions across 19 of 31 (61%) participants, with a median ± interquartile range number and volume of 1 ± 2.8 lesions and 20 ± 190 μL per patient. By volume, 80% of the infarcts were cortical, 90% in the posterior circulation and 81% in the right hemisphere. Conclusions The distribution of lesions that we detected suggests that cortical gray matter, the posterior circulation, and the right hemisphere are all particularly vulnerable to perioperative cerebrovascular injury. This finding has implications for the use of intraoperative cerebral embolic protection devices, particularly those that leave the left subclavian and, therefore, left vertebral artery unprotected. |
| Databáze: | OpenAIRE |
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