Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study

Omran, Heyder; Schmidt, Harald; Hackenbroch, M. H.; Illien, Stefan; Bernhardt, Peter; Recke, Giso von der; Fimmers, Rolf; Flacke, Sebastian; Layer, G.; Pohl, Christoph; Lüderitz, Berndt; Schild, Hans H.; Sommer, Torsten

doi:10.1016/s0140-6736(03)12978-9

Cited by 375 publications

(214 citation statements)

References 15 publications

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“…The latter increases the risk of dislodgment of calcific microdebris from the degenerative leaflets. Catheter manipulation of the calcified stenotic valve increases this risk, and it has been shown previously that cerebral embolism as detected by DWI occurs even after valve passage with relatively soft diagnostic catheters [21]. In our study, however, aortic valve calcification was not significantly associated with either the number or volume of the new cerebral ischemic lesions.…”

Section: Discussioncontrasting

confidence: 64%

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

et al. 2015

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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 ll (10.0, 42.7) and the total ischemic lesion volume was 132.3 ll (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 ll) and located in the cortical regions of the cerebral hemispheres. An independent association was found between age, hyperlipidaemia and balloon postdilatation 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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Section: Discussioncontrasting

confidence: 64%

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

et al. 2015

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“…The link between sex and AS is controversial and that with AVC is unknown. 46). Conversely, AVC load was lower in women versus men (1703±1321 versus 2694±1628 arbitrary units; P<0.0001) even after adjustment for their smaller body surface area or aortic annular area (both P<0.0001).…”

mentioning

confidence: 83%

“…[39][40][41] Doppler echocardiography at rest is not conclusive in such patients, requiring additional testing to differentiate truly severe from pseudosevere AS. 35,38,42,43 Catheterization is often not helpful because of similar discrepancies in AS severity markers, 44 whereas crossing the aortic valve also carries a significant risk of cerebral embolism, 45,46 and stress Doppler echocardiography is not always conclusive. 35 Hence, CT has emerged as an adjunct to Doppler echocardiography in the determination of AS severity.…”

Section: Avc-as Diagnosismentioning

confidence: 99%

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Aggarwal

Clavel

Messika–Zeitoun

et al. 2013

Circ: Cardiovascular Imaging

212

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A ortic stenosis (AS) is common in elderly people, affecting 2% of the population ≥65 years old and 4.6% of population ≥75 years old based on Doppler echocardiographic or community studies.1,2 Nowadays, the most common cause of AS is degenerative, and aortic valve calcification (AVC) is the intrinsic mechanism of valvular stiffening and obstruction. [3][4][5][6] Although degenerative AS has long been considered age related, recent studies have demonstrated that it is an active process involving biological pathways with many similarities to atherosclerosis. 7,8 Epidemiological studies identified similar risk factors for calcific AS and coronary atherosclerosis such as age, smoking, elevated cholesterol levels, diabetes mellitus, metabolic syndrome, hypertension, and increase in lipoprotein-a levels. 9 Male sex was also touted as an independent risk factor for AS similar to atherosclerosis, 9 but studies linking valve tissue alterations 10,11 and calcification to AS 12 have not differentiated between men and women. Moreover, studies of aortic valve weight as a surrogate for calcification load showed discordant results with regard to sex, 13,14 and clinically, guidelines do not differentiate between men and women for AS pathophysiology and management. 6 However, the analogy to atherosclerosis suggests that there may be important, yet thus far undefined, sex-related differences in the development of AVC and the transition to AS. This issue can now be analyzed because cardiac computed tomography (CT) provides accurate and reproducible quantification of AVC load, 15 and multidetector CT (MDCT) may prove to be a useful adjunct tool for the evaluation of AS severity. However, previous studies suggested a single set of cutoff values for detecting severe AS regardless of sex, 16 so the impact of sex on the relation between aortic cusp calcification measured by MDCT and hemodynamic severity of AS remains uncertain. The aim of the present study was to determine the differential physiological relationship between AVC Background-Aortic valve calcification (AVC) is the intrinsic mechanism of valvular obstruction leading to aortic stenosis (AS) and is measurable by multidetector computed tomography. The link between sex and AS is controversial and that with AVC is unknown. Methods and Results-We Conclusions-In Aggarwal et al Aortic Valve Calcification in Women 41load and AS hemodynamic severity between men and women. We hypothesized that women reach thresholds for severe AS for lower calcification loads than men and that when MDCT is used for the diagnosis of AS severity, criteria of AVC load would need to be adjusted specifically for each sex. Methods Study PopulationWe prospectively enrolled patients with at least mild calcific AS in whom we performed noncontrast MDCT scan for the evaluation of AVC and comprehensive transthoracic echocardiography within 90 Creatinine Clearance age k gPatients from the Bichat Hospital were enrolled in 2 ongoing prospective studies on aortic valve calcification/stenosis (COFRASA; www.clinica...

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“…7,8 Moreover, silent cerebral embolism has also been shown in extracranial angiographic procedures. 9 Basically, embolic events during IA-DSA may be caused by either thromboembolism or air embolism introduced by injection of contrast medium or catheter flushing.…”

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confidence: 99%

Heparin and Air Filters Reduce Embolic Events Caused by Intra-Arterial Cerebral Angiography

et al. 2004

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Background-Intra-arterial cerebral angiography is associated with a low risk for neurological complications, but clinically silent ischemic events after angiography have been seen in a substantial number of patients. Methods and Results-In a prospective study, diffusion-weighted magnetic resonance imaging (DW-MRI) before and after intra-arterial cerebral angiography and transcranial Doppler sonography during angiography were used to evaluate the frequency of cerebral embolism. One hundred fifty diagnostic cerebral angiographies were randomized into 50 procedures, each using conventional angiographic technique, or systemic heparin treatment throughout the procedure, or air filters between the catheter and both the contrast medium syringe and the catheter flushing. There was no neurological complication during or after angiography. Overall, DW-MRI revealed 26 new ischemic lesions in 17 patients (11%). In the control group, 11 patients showed a total of 18 lesions. In the heparin group, 3 patients showed a total of 4 lesions. In the air filter group, 3 patients exhibited a total of 4 lesions. The reduced incidence of ischemic events in the heparin and air filter groups compared with the control group was significantly different (Pϭ0.002).Transcranial Doppler sonography demonstrated a large number of microembolic signals that was significantly lower in the air filter group compared with the heparin and control groups (PϽ0.01), which did not differ from each other. Conclusions-Air filters and heparin both reduce the incidence of silent ischemic events detected by DW-MRI after intra-arterial cerebral angiography and can potentially lower clinically overt ischemic complications. This may apply to any intra-arterial angiographic procedure.

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Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study

Cited by 375 publications

References 15 publications

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

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

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Heparin and Air Filters Reduce Embolic Events Caused by Intra-Arterial Cerebral Angiography

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