Author + information
- Received November 4, 2019
- Revision received February 28, 2020
- Accepted March 3, 2020
- Published online June 1, 2020.
- Marco De Carlo, MD, PhDa,∗ (, )
- Riccardo Liga, MDa,
- Gianmichele Migaleddu, MDb,
- Melania Scatturin, MDc,
- Carmen Spaccarotella, MDd,
- Claudia Fiorina, MDe,
- Giovanni Orlandi, MDf,
- Francesco De Caro, MDa,
- Marco L. Rossi, MDc,
- Alaide Chieffo, MDg,
- Ciro Indolfi, MDd,
- Bernhard Reimers, MDc,
- Mirco Cosottini, MDb and
- A. Sonia Petronio, MDa
- aCardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- bDepartment of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- cDepartment of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- dDivision of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- eCatheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
- fNeurological Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- gInterventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- ↵∗Address for correspondence:
Dr. Marco De Carlo, Cardiothoracic and Vascular Department, Ospedale Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
Objectives The aim of this study was to assess the characteristics, predictors, evolution, and neurocognitive effects of silent cerebral ischemic lesions (SCILs).
Background Most patients undergoing transcatheter aortic valve replacement (TAVR) develop SCILs detectable on magnetic resonance imaging (MRI). The natural history and clinical relevance of SCILs are not well established.
Methods Cerebral MRI was performed within 7 days before TAVR to assess baseline status and age-related white matter change score. MRI was repeated post-operatively to assess the occurrence, location, number, and dimensions of SCILs. Patients developing SCILs underwent a third MRI examination at 3- to 5-month follow-up. A neurocognitive evaluation was performed before TAVR, at discharge, and at 3-month follow-up.
Results Of the 117 patients enrolled, 96 underwent post-procedural MRI; SCILs were observed in 76% of patients, distributed in all vascular territories, with a median number of 2 lesions, a median diameter of 4.5 mm, and a median total volume of 140 mm3. Independent predictors of SCIL occurrence were higher baseline age-related white matter change score and the use of self-expanding or mechanically expanded bioprostheses. Among 47 patients who underwent follow-up MRI, only 26.7% of post-procedural SCILs evolved into gliotic scar. SCIL occurrence was associated with a more pronounced transient neurocognitive decline early after TAVR and with lower recovery at follow-up.
Conclusions SCILs occur in the vast majority of patients undergoing TAVR and are predicted by more diffuse white matter damage at baseline and by the use of non-balloon-expandable prostheses. Although most SCILs disappear within months, their occurrence has a limited but significant impact on neurocognitive function.
- cerebral magnetic resonance imaging
- neurocognitive function
- silent cerebral ischemic lesions
- transcatheter aortic valve replacement
This study was funded through unrestricted grants from Edwards Lifesciences and Medtronic Italia. Prof. Petronio has received personal consultancy fees and institutional research grants from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received November 4, 2019.
- Revision received February 28, 2020.
- Accepted March 3, 2020.
- 2020 American College of Cardiology Foundation
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