Self-expandable transcatheter aortic valve replacement is associated with frequent periprocedural stroke detected by diffusion-weighted magnetic resonance imaging

• Published in: Journal of cardiology 2019-07, Vol.74 (1), p.27-33
• Main Authors: Kajio, Keiko, Mizutani, Kazuki, Hara, Masahiko, Nakao, Mana, Okai, Tsukasa, Ito, Asahiro, Takahashi, Yosuke, Iwata, Shinichi, Shimono, Taro, Izumiya, Yasuhiro, Murakami, Takashi, Shibata, Toshihiko, Yoshiyama, Minoru
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Diffusion-weighted magnetic resonance imaging; Self-expandable valve; Stroke; Transcatheter aortic valve replacement
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2019.01.013

•DW-MRI could diagnose asymptomatic stroke by depicting HIA.•More than half of patients underwent TAVR had asymptomatic stroke.•The number of HIA on DW-MRI increased when self-expandable TAVR was performed. Little evidence is available regarding the risk of peri-procedural stroke detected by diffusion-weighted magnetic resonance imaging (DW-MRI) after transcatheter aortic valve replacement (TAVR). Our purpose was to evaluate stroke risk after TAVR using DW-MRI by enrolling consecutive patients who underwent transfemoral TAVR and post-procedural DW-MRI. We prospectively enrolled 113 consecutive patients who underwent transfemoral TAVR and post-procedural DW-MRI. We used balloon-expandable valves as first-line therapy and selected self-expandable valves only for patients with narrow sinotubular junctions or annuli. We set the primary endpoint as the number of high intensity areas (HIA) detected by DW-MRI regardless of the size of the area. To evaluate the risks of the primary endpoint, we employed a multivariable linear regression model, setting the primary endpoint as an objective variable and patient and clinical backgrounds as explanatory variables. Median patient age was 84 years, and 36.3% were men. Ninety-three patients underwent balloon-expandable TAVR and 20 underwent self-expandable TAVR. Symptomatic stroke occurred in 6 (5.3%) whereas asymptomatic stroke occurred in 59 (52.2%) patients. The incidence of symptomatic and total stroke was higher in patients who underwent self-expandable TAVR than those who underwent balloon-expandable TAVR (30.0% vs. 0.0%, p