PMID- 36277778 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221025 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 9 DP - 2022 TI - Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves. PG - 951943 LID - 10.3389/fcvm.2022.951943 [doi] LID - 951943 AB - AIMS: To evaluate the patient- and procedure-related predictors of transcatheter aortic-valve implantation (TAVI)-associated ischemic brain lesions and to assess the effect of silent cerebral ischemic lesions (SCIL) on neurocognitive function. METHODS AND RESULTS: We investigated 113 consecutive patients with severe aortic stenosis who underwent brain magnetic resonance imaging (MRI) within a week following TAVI. To assess periprocedural cerebral ischemic lesions, diffusion-weighted MRI was utilized. We used multivariate linear regression to identify the independent predictors of TAVI-related ischemic lesion volume (ILV) and periprocedural stroke. Neurocognitive evaluation was performed before and following TAVI at 6-month and one-year follow-up. Following TAVI, a total of 944 new cerebral ischemic lesions were detected in 104 patients (92%). The median ILV was 257 mul (interquartile range [IQR]:97.1-718.8mul) with a median lesion number of 6/patient [IQR:2-10]. The majority of ischemic lesions were clinically silent (95%), while 5% of the lesions induced a stroke, which was confirmed by MRI. Predilatation (beta = 1.13[95%CI:0.32-1.93], p = 0.01) and the number of valve positioning attempts during implantation (beta = 0.28[95%CI:0.06-0.50], p = 0.02) increased the log-transformed total ILV. Predilatation (OR = 12.04[95%CI:1.46-99.07], p = 0.02) and alternative access routes (OR = 7.84[95%CI:1.01-61.07], p = 0.02) were associated with stroke after adjustments for comorbidities and periprocedural factors. The presence of SCILs were not associated with a change in neurocognitive function that remained stable during the one-year follow-up. CONCLUSION: While periprocedural ischemic lesions are frequent, most of them are clinically silent and might not impact the patients' neurocognitive function. The number of valve positioning attempts, predilatation, and alternative access routes should be taken into consideration during TAVI to reduce the ILV and risk for stroke. CI - Copyright (c) 2022 Suhai, Varga, Szilveszter, Nagy-Vecsey, Apor, Nagy, Kolossvary, Karady, Bartykowszki, Molnar, Jermendy, Panajotu, Maurovich-Horvat and Merkely. FAU - Suhai, Ferenc Imre AU - Suhai FI AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Varga, Andrea AU - Varga A AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Szilveszter, Balint AU - Szilveszter B AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Nagy-Vecsey, Milan AU - Nagy-Vecsey M AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Apor, Astrid AU - Apor A AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Nagy, Aniko Ilona AU - Nagy AI AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. AD - Department of Medicine, Karolinska Institute, Stockholm, Sweden. FAU - Kolossvary, Marton AU - Kolossvary M AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. AD - Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States. FAU - Karady, Julia AU - Karady J AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. AD - Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States. FAU - Bartykowszki, Andrea AU - Bartykowszki A AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Molnar, Levente AU - Molnar L AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Jermendy, Adam L AU - Jermendy AL AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Panajotu, Alexisz AU - Panajotu A AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. FAU - Maurovich-Horvat, Pal AU - Maurovich-Horvat P AD - Medical Imaging Center, Semmelweis University, Budapest, Hungary. FAU - Merkely, Bela AU - Merkely B AD - Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. LA - eng PT - Journal Article DEP - 20221005 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC9581280 OTO - NOTNLM OT - cardiac CT angiography (CTA) OT - cerebral embolism OT - magnetic resonance imaging OT - stroke OT - transcatheter aortic valve implantation COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2022/10/25 06:00 MHDA- 2022/10/25 06:01 PMCR- 2022/01/01 CRDT- 2022/10/24 04:38 PHST- 2022/05/24 00:00 [received] PHST- 2022/09/09 00:00 [accepted] PHST- 2022/10/24 04:38 [entrez] PHST- 2022/10/25 06:00 [pubmed] PHST- 2022/10/25 06:01 [medline] PHST- 2022/01/01 00:00 [pmc-release] AID - 10.3389/fcvm.2022.951943 [doi] PST - epublish SO - Front Cardiovasc Med. 2022 Oct 5;9:951943. doi: 10.3389/fcvm.2022.951943. eCollection 2022.