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Silent ischemic brain lesions after transcatheter aortic valve replacement: lesion distribution and predictors

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Abstract

Aims

Silent ischemic brain lesions and ischemic stroke are known complications of transcatheter aortic valve replacement (TAVR). We aimed to investigate the occurrence and distribution of TAVR-related silent ischemic brain lesions using diffusion-weighted magnetic resonance imaging (DWI).

Methods

Consecutive patients with severe aortic valve stenosis treated with TAVR underwent cerebral DWI within 5 days after the index procedure. DWI scans were analyzed for the occurrence and distribution of new ischemic lesions post-TAVR.

Results

Forty-two patients were enrolled in this study. After TAVR, a total of 276 new cerebral ischemic lesions were detected in 38 (90 %) patients, with a median of 4.5 (interquartile range 2.0–7.0) lesions per patient. A total of 129 (47 %) lesions were detected in the cortical regions, 97 (35 %) in the subcortical regions, and 50 (18 %) in the cerebellum or brainstem. The median lesion volume was 20.2 µl (10.0, 42.7) and the total ischemic lesion volume was 132.3 µl (42.8, 336.9). The new ischemic brain lesions were clinically silent in 37 (97 %) patients; the other patient had a transient ischemic attack. Age (B = 0.528, p = 0.015), hyperlipidaemia (B = 5.809, p = 0.028) and post-dilatation of the implanted prosthesis (B = 7.196, p = 0.029) were independently associated with the number of post-TAVR cerebral DWI lesions. In addition, peak transaortic gradient was independently associated with post-procedural total infarct volume.

Conclusion

Clinically silent cerebral infarcts occurred in 90 % of patients following TAVR, most of which were small (<20 μl) and located in the cortical regions of the cerebral hemispheres. An independent association was found between age, hyperlipidaemia and balloon post-dilatation and the number of post-TAVR ischemic brain lesions. Only peak transaortic gradient was independently associated with post-procedural total infarct volume.

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Acknowledgments

H.B. van der Worp is supported by a grant from the Dutch Heart Foundation (2010T075).

Conflict of interest

Dr. P.R. Stella is a physician proctor for Edwards Lifesciences. All other co-authors have no relations to disclose.

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Authors and Affiliations

  1. Department of Cardiology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, Room E. 05.2308, 3584 CX, Utrecht, The Netherlands

    Mariam Samim, Pierfrancesco Agostoni, Freek Nijhoff, Pieter A. Doevendans & Pieter R. Stella

  2. Department of Radiology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands

    Jeroen Hendrikse

  3. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Centre, Utrecht, The Netherlands

    H. Bart van der Worp

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  1. Mariam Samim
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  2. Jeroen Hendrikse
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  3. H. Bart van der Worp
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  4. Pierfrancesco Agostoni
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  5. Freek Nijhoff
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  6. Pieter A. Doevendans
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  7. Pieter R. Stella
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Correspondence to Mariam Samim.

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Samim, M., Hendrikse, J., van der Worp, H.B. et al. Silent ischemic brain lesions after transcatheter aortic valve replacement: lesion distribution and predictors. Clin Res Cardiol 104, 430–438 (2015). https://doi.org/10.1007/s00392-014-0798-8

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  • DOI: https://doi.org/10.1007/s00392-014-0798-8

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