Silent cerebral injury after transcatheter aortic valve implantation and the preventive role of embolic protection devices

A systematic review and meta-analysis

Matteo Pagnesi, Enrico A. Martino, Mauro Chiarito, Antonio Mangieri, Richard J. Jabbour, Nicolas M. Van Mieghem, Susheel K. Kodali, Cosmo Godino, Giovanni Landoni, Antonio Colombo, Azeem Latib

Research output: Contribution to journalArticle

29 Citations (Scopus)

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 languageEnglish
Pages (from-to)97-106
Number of pages10
JournalInternational Journal of Cardiology
Volume221
DOIs
Publication statusPublished - Oct 15 2016

Fingerprint

Embolic Protection Devices
Meta-Analysis
Diffusion Magnetic Resonance Imaging
Wounds and Injuries
Confidence Intervals
Transcatheter Aortic Valve Replacement
Prospective Studies
Equipment and Supplies

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 journalArticle

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. / Silent cerebral injury after transcatheter aortic valve implantation and the preventive role of embolic protection devices : A systematic review and meta-analysis. In: International Journal of Cardiology. 2016 ; Vol. 221. pp. 97-106.
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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.",
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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

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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.

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KW - Cerebral ischemia

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KW - Magnetic resonance imaging

KW - Meta-analysis

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