Calcific aortic valve and spontaneous embolic stroke: A review of literature

• Published in: Journal of the neurological sciences Vol. 287; no. 1; pp. 32 - 35
• Main Authors: Khetarpal, Vipin, Mahajan, Nitin, Madhavan, Ramesh, Batra, Sachin, Mopala, Prashanth, Sagar, Amit, Rapolu, Praveen, Nangia, Sharad, Afonso, Luis
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 15.12.2009; Elsevier
• Subjects: Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - therapy; Biological and medical sciences; Calcific aortic valve; Calcinosis - diagnosis; Calcinosis - epidemiology; Calcinosis - therapy; Cardiac Surgical Procedures - standards; Cerebral embolism; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - prevention & control; Comorbidity; Diagnostic Imaging - standards; Humans; Intracranial Embolism - diagnosis; Intracranial Embolism - epidemiology; Intracranial Embolism - therapy; Medical sciences; Neurology; Platelet Aggregation Inhibitors - therapeutic use; Stroke - diagnosis; Stroke - epidemiology; Stroke - therapy; Vascular diseases and vascular malformations of the nervous system; Cerebral embolism; Calcific aortic valve; Vascular disease; Stroke; Nervous system diseases; Central nervous system disease; Cardiovascular disease; Aortic valve; Cerebrovascular disease; Cerebral disorder
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2009.07.018

Abstract Aortic valve calcification is common in the elderly and in patients with congenital bicuspid aortic valve but unlike calcific mitral valve disease it is not a well recognized risk factor for stroke. Although autopsy studies have revealed evidence of systemic embolism in one-third of cases with calcific aortic valves, there is conflicting data from larger clinical studies examining the association between calcific aortic valve and stroke. There are only 8 reported cases of symptomatic stroke from spontaneous cerebral thromboembolism associated with calcific aortic valve in the literature. Computerized tomography (CT) angiography and CT without contrast are modalities of choice to diagnose calcific embolism, while MRI may be useful in delineating the extent of ischemia. Ideal management strategy, the role of antiplatelet therapy, anticoagulation or recommendations for valve replacements are poorly defined. We present a focused literature review on this topic.