The DOI matches its Crossref record; 31 of the 31 references it cites were found in a registry or an index.
Silent and Apparent Cerebral Ischemia After Percutaneous Transfemoral Aortic Valve Implantation: A Diffusion-Weighted Magnetic Resonance Imaging Study
Abstract
Background— The risk of stroke after transfemoral aortic valve implantation (TAVI) due to dislodgement and subsequent embolization of debris from aortic arch atheroma or from the calcified valve itself ranges between 2% and 10%. The rate of clinically silent cerebral ischemia is unknown but may be even higher. Methods and Results— Thirty-two patients who underwent TAVI with the use of a balloon-expandable (n=22) or self-expandable (n=10) stent valve prosthesis were included in this descriptive study and compared with a historical control group of 21 patients undergoing open surgical aortic valve replacement. Periprocedural apparent and silent cerebral ischemia was assessed by neurological testing and serial cerebral diffusion-weighted magnetic resonance imaging at baseline, at 3.4 (2.5 to 4.4) days after the procedure, and at 3 months. TAVI was successful in all patients. After the procedure, new foci of restricted diffusion on cerebral diffusion-weighted magnetic resonance imaging were found in 27 of 32 TAVI patients (84%) and were more frequent than after open surgery (10 of 21 patients [48%]; P =0.011). These lesions were usually multiple (1 to 19 per patient) and dispersed in both hemispheres in a pattern suggesting cerebral embolization. Volumes of these lesions were significantly smaller after TAVI than after surgery (77 [59 to 94] versus 224 [111 to 338] mm 3 ; P <0.001). There were neither measurable impairments of neurocognitive function nor apparent neurological events during the in-hospital period among TAVI patients, but there was 1 stroke (5%) in the surgical patient group. On 3-month follow-up diffusion-weighted magnetic resonance imaging, there were no new foci of restricted diffusion, and there was no residual signal change associated with the majority (80%) of the foci detected in the periprocedural period. Conclusions— Clinically silent new foci of restricted diffusion on cerebral magnetic resonance imaging were detected in almost all patients (84%) undergoing TAVI. Although typically multiple, these foci were not associated with apparent neurological events or measurable deterioration of neurocognitive function during 3-month follow-up. Further work needs to be directed to determine the clinical significance of these findings in a larger patient population.
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Cites
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European system for cardiac operative risk evaluation (EuroSCORE)
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Cited by
Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery
Leon, M. B., Smith, C. R., Mack, M., Miller, D. C., Moses, J. W., Svensson, L. G., Tuzcu, E. M., Webb, J. G., Fontana, G. P., Makkar, R. R., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1008232 · Cited by 7,205
Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients
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VARC-3 WRITING COMMITTEE, Généreux, P., Piazza, N., Alu, M. C., Nazif, T., Hahn, R. T., Pibarot, P., Bax, J. J., Leipsic, J. A., Blanke, P., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa799 · Cited by 915
Moat, N. E., Ludman, P., de Belder, M. A., Bridgewater, B., Cunningham, A. D., Young, C. P., Thomas, M., Kovac, J., Spyt, T., MacCarthy, P. A., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.08.050 · Cited by 884
Metadata
- Authors
- Kahlert, P., Knipp, S. C., Schlamann, M., Thielmann, M., Al-Rashid, F., Weber, M., Johansson, U., Wendt, D., Jakob, H. G., Forsting, M., Sack, S., Erbel, R., & Eggebrecht, H.
- Venue
- Circulation
- Published
- 2010-02-23
- Volume
- 121
- Issue
- 7
- Pages
- 870-878
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2064415896
- Cited by
- 521
- References
- 31
- FWCI
- 35.77
- Type
- journal article
- Language
- en
- Open access
- closed
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- Kahlert, P., Knipp, S. C., Schlamann, M., Thielmann, M., Al-Rashid, F., Weber, M., Johansson, U., Wendt, D., Jakob, H. G., Forsting, M., Sack, S., Erbel, R., & Eggebrecht, H. (2010). Silent and Apparent Cerebral Ischemia After Percutaneous Transfemoral Aortic Valve Implantation: A Diffusion-Weighted Magnetic Resonance Imaging Study. Circulation. https://doi.org/10.1161/circulationaha.109.855866
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