Abstract
Background The aims of this study were: 1) to evaluate silent cerebral injury detected by cerebral diffusion weighted magnetic resonance imaging (DW-MRI) after transcatheter aortic valve implantation (TAVI); and 2) to assess the efficacy of embolic protection devices (EPDs) on DW-MRI endpoints. Methods We included in a pooled analysis 25 prospective studies reporting post-procedural cerebral DW-MRI data after TAVI (n = 1225). Among these studies, we included in a meta-analysis 6 studies investigating TAVI performed with versus without EPDs (n = 384). Primary endpoints were the number of new lesions per patient and the total lesion volume, while secondary endpoints were the number of patients with new lesions and the single lesion volume. Results The main pooled DW-MRI outcomes were: patients with new ischemic lesions, 77.5% (95% confidence interval = 71.7–83.3%); total lesion volume, 437.5 mm3 (286.7–588.3 mm3); single lesion volume, 78.1 mm3 (56.7–99.5 mm3); and number of new lesions per patient, 4.2 (3.4–5.0). The use of EPDs was associated with a significant reduction in total lesion volume (mean difference [95% confidence interval] = − 111.1 mm3 [− 203.6 to − 18.6 mm3]; p = 0.02) and single lesion volume (− 12.1 mm3 [− 18.3 to − 6.0 mm3]; p = 0.0001) after TAVI. Conclusions Silent cerebral injury occurs in the majority of patients undergoing TAVI and DW-MRI allows a precise characterization of new ischemic brain lesions. EPDs reduce the total and single volume of such lesions detected after the procedure, although the number of new lesions per patient and the number of patients with new lesions are not significantly reduced by such devices.
| Original language | English |
|---|---|
| Pages (from-to) | 97-106 |
| Number of pages | 10 |
| Journal | International Journal of Cardiology |
| Volume | 221 |
| DOIs | |
| Publication status | Published - Oct 15 2016 |
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Keywords
- Brain injury
- Cerebral ischemia
- Cerebral protection device
- Magnetic resonance imaging
- Meta-analysis
- TAVI
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Silent cerebral injury after transcatheter aortic valve implantation and the preventive role of embolic protection devices : A systematic review and meta-analysis. / Pagnesi, Matteo; Martino, Enrico A.; Chiarito, Mauro; Mangieri, Antonio; Jabbour, Richard J.; Van Mieghem, Nicolas M.; Kodali, Susheel K.; Godino, Cosmo; Landoni, Giovanni; Colombo, Antonio; Latib, Azeem.
In: International Journal of Cardiology, Vol. 221, 15.10.2016, p. 97-106.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Silent cerebral injury after transcatheter aortic valve implantation and the preventive role of embolic protection devices
T2 - A systematic review and meta-analysis
AU - Pagnesi, Matteo
AU - Martino, Enrico A.
AU - Chiarito, Mauro
AU - Mangieri, Antonio
AU - Jabbour, Richard J.
AU - Van Mieghem, Nicolas M.
AU - Kodali, Susheel K.
AU - Godino, Cosmo
AU - Landoni, Giovanni
AU - Colombo, Antonio
AU - Latib, Azeem
PY - 2016/10/15
Y1 - 2016/10/15
N2 - Background The aims of this study were: 1) to evaluate silent cerebral injury detected by cerebral diffusion weighted magnetic resonance imaging (DW-MRI) after transcatheter aortic valve implantation (TAVI); and 2) to assess the efficacy of embolic protection devices (EPDs) on DW-MRI endpoints. Methods We included in a pooled analysis 25 prospective studies reporting post-procedural cerebral DW-MRI data after TAVI (n = 1225). Among these studies, we included in a meta-analysis 6 studies investigating TAVI performed with versus without EPDs (n = 384). Primary endpoints were the number of new lesions per patient and the total lesion volume, while secondary endpoints were the number of patients with new lesions and the single lesion volume. Results The main pooled DW-MRI outcomes were: patients with new ischemic lesions, 77.5% (95% confidence interval = 71.7–83.3%); total lesion volume, 437.5 mm3 (286.7–588.3 mm3); single lesion volume, 78.1 mm3 (56.7–99.5 mm3); and number of new lesions per patient, 4.2 (3.4–5.0). The use of EPDs was associated with a significant reduction in total lesion volume (mean difference [95% confidence interval] = − 111.1 mm3 [− 203.6 to − 18.6 mm3]; p = 0.02) and single lesion volume (− 12.1 mm3 [− 18.3 to − 6.0 mm3]; p = 0.0001) after TAVI. Conclusions Silent cerebral injury occurs in the majority of patients undergoing TAVI and DW-MRI allows a precise characterization of new ischemic brain lesions. EPDs reduce the total and single volume of such lesions detected after the procedure, although the number of new lesions per patient and the number of patients with new lesions are not significantly reduced by such devices.
AB - Background The aims of this study were: 1) to evaluate silent cerebral injury detected by cerebral diffusion weighted magnetic resonance imaging (DW-MRI) after transcatheter aortic valve implantation (TAVI); and 2) to assess the efficacy of embolic protection devices (EPDs) on DW-MRI endpoints. Methods We included in a pooled analysis 25 prospective studies reporting post-procedural cerebral DW-MRI data after TAVI (n = 1225). Among these studies, we included in a meta-analysis 6 studies investigating TAVI performed with versus without EPDs (n = 384). Primary endpoints were the number of new lesions per patient and the total lesion volume, while secondary endpoints were the number of patients with new lesions and the single lesion volume. Results The main pooled DW-MRI outcomes were: patients with new ischemic lesions, 77.5% (95% confidence interval = 71.7–83.3%); total lesion volume, 437.5 mm3 (286.7–588.3 mm3); single lesion volume, 78.1 mm3 (56.7–99.5 mm3); and number of new lesions per patient, 4.2 (3.4–5.0). The use of EPDs was associated with a significant reduction in total lesion volume (mean difference [95% confidence interval] = − 111.1 mm3 [− 203.6 to − 18.6 mm3]; p = 0.02) and single lesion volume (− 12.1 mm3 [− 18.3 to − 6.0 mm3]; p = 0.0001) after TAVI. Conclusions Silent cerebral injury occurs in the majority of patients undergoing TAVI and DW-MRI allows a precise characterization of new ischemic brain lesions. EPDs reduce the total and single volume of such lesions detected after the procedure, although the number of new lesions per patient and the number of patients with new lesions are not significantly reduced by such devices.
KW - Brain injury
KW - Cerebral ischemia
KW - Cerebral protection device
KW - Magnetic resonance imaging
KW - Meta-analysis
KW - TAVI
UR - http://www.scopus.com/inward/record.url?scp=84977602928&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84977602928&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2016.06.143
DO - 10.1016/j.ijcard.2016.06.143
M3 - Article
VL - 221
SP - 97
EP - 106
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -