Stroke Associated With Surgical and Transcatheter Treatment of Aortic Stenosis

Daneault, Benoit; Kirtane, Ajay J.; Kodali, Susheel; Williams, Mathew; Généreux, Philippe; Reiss, George R.; Smith, Craig R.; Moses, Jeffrey W.; Leon, Martin B.

doi:10.1016/j.jacc.2011.08.024

Cited by 148 publications

(86 citation statements)

References 62 publications

(66 reference statements)

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“…That complication might be related to atheroembolism of plaques in the ascending aorta and aortic arch, embolization of calcified debris of native aortic valve leaflets, thromboembolism originating from the valvular prosthesis, and the occasional occurrence of atrial fibrillation, as might have occurred in one of our patients. In the PARTNER trial, only approximately half of the cases of stroke occurred during the procedure, which, along with our findings, raise the question about the efficacy of protective devices against cerebral embolism when used only at the occasion of prosthesis implantation 8,10,23 .…”

Section: Discussionmentioning

confidence: 56%

Implante por cateter de bioprótese valvar para tratamento da estenose aórtica: experiência de três anos

Brito¹,

Abizaid²,

Almeida³

et al. 2012

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 56%

Implante por cateter de bioprótese valvar para tratamento da estenose aórtica: experiência de três anos

Brito¹,

Abizaid²,

Almeida³

et al. 2012

Arq. Bras. Cardiol.

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“…Although the clinical relevance of these DWI lesions remains uncertain, they may cause decline in cognitive function as suggested by previous reports on silent cerebral lesions involving patients other than the typical TAVR patients [11,12,22]. For instance, the population-based Rotterdam Scan Study showed that elderly people with silent brain infarcts have an increased risk of dementia and a steeper decline in cognitive function than those without such lesions [11,12,22]. Therefore, based on these previous reports, the high frequency of ischemic lesions on post-TAVR cerebral imaging calls for procedural and technical developments to reduce the risk of peri-procedural embolization.…”

Section: Discussionmentioning

confidence: 90%

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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“…Recent data have suggested comparable or higher risk of stroke after transcatheter AVR compared with conventional AVR. [20][21][22][23] This is concerning in the context of observational studies demonstrating an incidence of cerebrovascular lesions, as detected by MRI, of >70% after transcatheter AVR. 24 Prevention of ischemic stroke is, therefore, of key importance for continued safe expansion of transcatheter AVR and conventional AVR.…”

Section: Discussionmentioning

confidence: 99%

Stroke in Patients With Aortic Stenosis

Greve

Dalsgaard

Bang

et al. 2014

Stroke

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T he most recent US and European guidelines for treatment of valvular heart disease recommend oral anticoagulation (OAC) for stroke prophylaxis in all patients with aortic stenosis (AS) complicated by atrial fibrillation (AF).1,2 This recommendation differs from nonvalvular AF, where the decision to start OAC is guided by the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex) risk scheme.3 The guideline discrepancy is based on observational studies indicating that calcific AS is an independent risk factor for stroke, 4 which may predict stroke even in the absence of AF.5 However, limited evidence exists on the effectiveness of the CHA 2 DS 2 -VASc scores in AS populations, and particularly in less severe AS where data are equivocal with regards to an increased stroke risk per se. 6 We hypothesized that calcific AS is associated with the same pathobiology underlying an increase in the CHA 2 DS 2 -VASc score and that the latter, therefore, could be particularly useful for stratifying risk of stroke in earlier stages of AS. This study was, therefore, undertaken to examine the ability of the CHA 2 DS 2 -VASc score to predict ischemic stroke in asymptomatic patients with AS with and without coexisting AF. Because risk of new-onset AF and thromboembolism may differ substantially in relation to aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG), the primary study hypothesis was stratified by AVR with and Background and Purpose-There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting influenced the predicted outcomes. Methods-Patients with mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic disease, and oral anticoagulation were exclusion criteria. Ischemic stroke was the primary end point, and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA 2 DS 2 -VASc) scores. Results-One thousand five hundred nine patients were followed for 4.3±0.8 years (6529 patient

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Stroke Associated With Surgical and Transcatheter Treatment of Aortic Stenosis

Cited by 148 publications

References 62 publications

Implante por cateter de bioprótese valvar para tratamento da estenose aórtica: experiência de três anos

Implante por cateter de bioprótese valvar para tratamento da estenose aórtica: experiência de três anos

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

Stroke in Patients With Aortic Stenosis

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