Asymptomatic Stroke in the Setting of Percutaneous Non-Coronary Intervention Procedures

Abstract

Advancements in clinical management, pharmacological therapy and interventional procedures have strongly improved the survival rate for cardiovascular diseases (CVDs). Nevertheless, the patients affected by CVDs are more often elderly and present several comorbidities such as atrial fibrillation, valvular heart disease, heart failure, and chronic coronary syndrome. Standard treatments are frequently not available for “frail patients”, in particular due to high surgical risk or drug interaction. In the past decades, novel less-invasive procedures such as transcatheter aortic valve implantation (TAVI), MitraClip or left atrial appendage occlusion have been proposed to treat CVD patients who are not candidates for standard procedures. These procedures have been confirmed to be effective and safe compared to conventional surgery, and symptomatic thromboembolic stroke represents a rare complication. However, while the peri-procedural risk of symptomatic stroke is low, several studies highlight the presence of a high number of silent ischemic brain lesions occurring mainly in areas with a low clinical impact. The silent brain damage could cause neuropsychological deficits or worse, a preexisting dementia, suggesting the need to systematically evaluate the impact of these procedures on neurological function.

Healthcare analytics—A literature review and proposed research agenda

“…Considering the lack of clinical signs, this cerebral ischemia's cumulative effect could be connected to dementia and cognitive dysfunction. In light of these factors, significant emphasis ought to be placed on cerebral embolism and preventive methods to limit the risk of silent cerebral ischemia during and after surgery (Ciccarelli et al, 2022 ). This could be achieved with the aid of BD and AI, where high-risk patients get to be supplied with wearable devices by their healthcare provider.…”