Cerebral Infarction after Transcatheter Aortic Valve Implantation in Japan: Retrospective Analysis at a Single High-Volume Center

• Published in: Journal of stroke and cerebrovascular diseases 2019-12, Vol.28 (12), p.104455-104455, Article 104455
• Main Authors: Iizuka, Takashi, Oki, Koichi, Hayashida, Kentaro, Minami, Kazushi, Izawa, Yoshikane, Takahashi, Shinichi, Shimizu, Hideyuki, Fukuda, Keiichi, Nakahara, Jin
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aortic stenosis; Aortic Valve Stenosis - surgery; cerebral infarction; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - etiology; Cerebral Infarction - therapy; Comorbidity; Female; Hospitals, High-Volume; Humans; Male; peripheral artery disease; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Tokyo; transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2019.104455

Perioperative cerebral infarction is one of the concerning complications after transcatheter aortic valve implantation in patients with aortic stenosis. Several studies have reported on this complication; however, those included only Caucasians and analyzed a small number of cases. Here, we report on the characteristics and risk factors of symptomatic cerebral infarction after transcatheter aortic valve implantation in a single, high-volume center in Japan. We included 308 consecutive patients who underwent transcatheter aortic valve implantation in our facility between 2013 and 2016. We retrospectively analyzed the occurrence, characteristics, and prognoses of symptomatic cerebral infarction within 7 days after the procedure and statistically compared the risk factors between patients with or without cerebral infarction. Five patients (1.6%) suffered from symptomatic cerebral infarction, which was usually recognized just after the procedure, with mild symptoms. Long-term prognoses tended to be good unless other factors influenced disability. Comorbidities, such as carotid artery stenosis and peripheral artery disease, were significantly higher in patients with cerebral infarction (P = .036 and .002, respectively); in addition, coronary artery disease and longer anesthesia duration (indicating challenging catheter procedures) tended to be associated with cerebral infarction (P = .080 and .069, respectively). Symptomatic cerebral infarction occurred in 1.6% of patients after transcatheter aortic valve implantation in a single, high-volume center in Japan; the infarctions were of mild severity tending toward good long-term prognoses. We speculate arterial embolism from atherosclerotic large arteries, especially from the aortic arch, during catheter procedures might be the mechanistic basis of cerebral infarction.