Topographical distribution of perioperative cerebral infarction associated with transcatheter aortic valve implantation
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 h...
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Published in | The American heart journal Vol. 197; pp. 113 - 123 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.03.2018
Elsevier Limited |
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Abstract | 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.
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.
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.
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.
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AbstractList | BackgroundTranscatheter 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.MethodsForty 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.ResultsMean ± 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.ConclusionsThe 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. 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. 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. 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. 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. 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. 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. 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. 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. [Display omitted] |
Author | Barnett, Adrian G. Platts, David G. Strugnell, Wendy E. Wong, Andrew A. Fanning, Jonathon P. Wesley, Allan J. Walters, Darren L. Fraser, John F. |
Author_xml | – sequence: 1 givenname: Jonathon P. surname: Fanning fullname: Fanning, Jonathon P. email: Jonathon_fanning@me.com organization: The Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia – sequence: 2 givenname: Allan J. surname: Wesley fullname: Wesley, Allan J. organization: The University of Queensland, Brisbane, Australia – sequence: 3 givenname: Darren L. surname: Walters fullname: Walters, Darren L. organization: The Heart & Lung Institute, Metro North Hospital and Health Service, Brisbane, Australia – sequence: 4 givenname: Andrew A. surname: Wong fullname: Wong, Andrew A. organization: The University of Queensland, Brisbane, Australia – sequence: 5 givenname: Adrian G. surname: Barnett fullname: Barnett, Adrian G. organization: The Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia – sequence: 6 givenname: Wendy E. surname: Strugnell fullname: Strugnell, Wendy E. organization: Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Australia – sequence: 7 givenname: David G. surname: Platts fullname: Platts, David G. organization: The Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia – sequence: 8 givenname: John F. surname: Fraser fullname: Fraser, John F. organization: The Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia |
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CitedBy_id | crossref_primary_10_3389_fcvm_2022_958732 crossref_primary_10_4244_EIJ_D_23_00166 crossref_primary_10_1016_j_jstrokecerebrovasdis_2019_104455 crossref_primary_10_1016_j_jstrokecerebrovasdis_2021_105665 crossref_primary_10_2176_nmc_oa_2021_0005 crossref_primary_10_1016_j_amjcard_2018_10_022 crossref_primary_10_2147_MDER_S234961 crossref_primary_10_15420_icr_2018_32_2 crossref_primary_10_1002_ccd_30143 crossref_primary_10_5847_wjem_j_1920_8642_2022_025 |
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Snippet | Transcatheter aortic valve implantation (TAVI) is associated with a high incidence of cerebrovascular injury. As these injuries are thought to be primarily... BackgroundTranscatheter aortic valve implantation (TAVI) is associated with a high incidence of cerebrovascular injury. As these injuries are thought to be... BACKGROUNDTranscatheter aortic valve implantation (TAVI) is associated with a high incidence of cerebrovascular injury. As these injuries are thought to be... |
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SubjectTerms | Anesthesia Aortic valve Blood clots Brain Brain injury Brain research Cerebral infarction Cerebrovascular system Cortex Heart Hemispheric laterality Hospitals Implantation Infarction Injuries Ischemia Lesions Magnetic resonance imaging Medical imaging Medical personnel Neuroimaging Neuropathology Neuroprotection NMR Nuclear magnetic resonance Patients Performance evaluation Stroke Substantia grisea Surgery Thorax Transplants & implants Veins & arteries Vertebrae |
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Title | Topographical distribution of perioperative cerebral infarction associated with transcatheter aortic valve implantation |
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