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Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation
Background Recent studies have shown that transcatheter aortic valve implantation (TAVI) is associated with new foci of restricted diffusion on cerebral magnetic resonance imaging suggestive of cerebral microembolism. The aim of the present investigation was to quantify the cerebral embolic load and...
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| Published in: | Acta anaesthesiologica Scandinavica 2012-02, Vol.56 (2), p.240-247 |
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| container_title | Acta anaesthesiologica Scandinavica |
| container_volume | 56 |
| creator | REINSFELT, B. WESTERLIND, A. IOANES, D. ZETTERBERG, H. FREDÉN-LINDQVIST, J. RICKSTEN, S.-E. |
| description | Background
Recent studies have shown that transcatheter aortic valve implantation (TAVI) is associated with new foci of restricted diffusion on cerebral magnetic resonance imaging suggestive of cerebral microembolism. The aim of the present investigation was to quantify the cerebral embolic load and to evaluate during which phase of the TAVI procedure microembolism occurs. We also evaluated the association between the cerebral embolic load and post‐procedural release of S100B, a serological marker of cerebral injury.
Methods
In 21 patients, we described the extent and intra‐procedural distribution of microemboli during the TAVI procedure using the transcranial Doppler technique. S100B, a marker of astroglial injury, was measured for 24 h after the procedure, and the area under the curve (AUC24h) relating S100B to time was calculated.
Results
During the TAVI procedure, a mean of 282 ± 169 emboli was detected, 37% occurred during manipulation of the aortic arch/root/valve by guide wires and catheters, 22% occurred immediately after balloon dilatation of the native valve and 41% occurred during frame expansion of the valve prosthesis. S100B increased in all patients with a peak at 1 h after the procedure and returned to baseline after 4 h. There was a positive correlation between the total amount of cerebral microemboli and the AUC24h for S100B (r = 0.68, P |
| doi_str_mv | 10.1111/j.1399-6576.2011.02563.x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_gup_ub_gu_se_149896</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1221142148</sourcerecordid><originalsourceid>FETCH-LOGICAL-i4033-85922b6c46b8d3bce160eff57708c3ec13dfff092e5cccaf1f7953e422a9a5393</originalsourceid><addsrcrecordid>eNp9kk1v1DAQhiMEotvCX0C-ILgk-CNO4gOHVaEFURUhFiFxsRxnsnjJF3ay3b3yy5l0l-0NH_z5zCvPzBtFhNGE4XizSZhQKs5kniWcMpZQLjOR7B5Fi9PD42hBKWWxZDk_i85D2OBRpEo9jc44pwrj-CL6s_KmCxYnZxryrh-GBjxpnfU9tGXfOEuCW3emCcR0FQngp5a0xv9CCraugs4C6WtSeuM64rrN5Pekmrzr1mS8lzbjTxiRNr0fUW1rmi0Q1w6N6UYzur57Fj2pUR-eH9eL6NvV-9Xlh_jm8_XHy-VN7FIqRFxIxXmZ2TQri0qUFlhGoa5lntPCCrBMVHVdY14grbWmZnWupICUc6OMFEpcRPFBN9zBMJV68A4T2eveOL2eBo1X60kH0CxVhcqQf3XgB9__niCMunXBQoMfh34KWrGMpbngEsnX_yUZ54ylnKUFoi-O6FS2UJ0-8a8jCLw8AgZr19RYQ-vCAyeFFFnOkHt74O5cA_vTO6N6doje6NkIejaCnh2i7x2id3q5_DrvHqrhwgi7Uzx2Vme5yKX-fnutf3y5XeH-E4r9BeMRwLs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1221142148</pqid></control><display><type>article</type><title>Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>REINSFELT, B. ; WESTERLIND, A. ; IOANES, D. ; ZETTERBERG, H. ; FREDÉN-LINDQVIST, J. ; RICKSTEN, S.-E.</creator><creatorcontrib>REINSFELT, B. ; WESTERLIND, A. ; IOANES, D. ; ZETTERBERG, H. ; FREDÉN-LINDQVIST, J. ; RICKSTEN, S.-E.</creatorcontrib><description>Background
Recent studies have shown that transcatheter aortic valve implantation (TAVI) is associated with new foci of restricted diffusion on cerebral magnetic resonance imaging suggestive of cerebral microembolism. The aim of the present investigation was to quantify the cerebral embolic load and to evaluate during which phase of the TAVI procedure microembolism occurs. We also evaluated the association between the cerebral embolic load and post‐procedural release of S100B, a serological marker of cerebral injury.
Methods
In 21 patients, we described the extent and intra‐procedural distribution of microemboli during the TAVI procedure using the transcranial Doppler technique. S100B, a marker of astroglial injury, was measured for 24 h after the procedure, and the area under the curve (AUC24h) relating S100B to time was calculated.
Results
During the TAVI procedure, a mean of 282 ± 169 emboli was detected, 37% occurred during manipulation of the aortic arch/root/valve by guide wires and catheters, 22% occurred immediately after balloon dilatation of the native valve and 41% occurred during frame expansion of the valve prosthesis. S100B increased in all patients with a peak at 1 h after the procedure and returned to baseline after 4 h. There was a positive correlation between the total amount of cerebral microemboli and the AUC24h for S100B (r = 0.68, P < 0.001). None of the patients developed neurological impairment.
Conclusion
TAVI is associated with a substantial amount of cerebral microemboli. The microembolic load correlates to the degree of post‐procedural release of a marker of cerebral injury.</description><identifier>ISSN: 0001-5172</identifier><identifier>ISSN: 1399-6576</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/j.1399-6576.2011.02563.x</identifier><identifier>PMID: 22092012</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>Oxford: Blackwell Publishing Ltd</publisher><subject>Aged ; Aged, 80 and over ; Anestesi och intensivvård ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthesiology and Intensive Care ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - surgery ; Aortic Valve - surgery ; Area Under Curve ; Biological and medical sciences ; Biomarkers ; Brain Injuries - diagnostic imaging ; Brain Injuries - etiology ; Cardiac Catheterization ; Cerebral Arteries - diagnostic imaging ; Female ; Heart Valve Prosthesis Implantation - adverse effects ; Humans ; Intracranial Embolism - diagnostic imaging ; Male ; Medical sciences ; Monitoring, Intraoperative ; S100 Proteins - blood ; Stroke Volume - physiology ; Ultrasonography, Doppler, Transcranial</subject><ispartof>Acta anaesthesiologica Scandinavica, 2012-02, Vol.56 (2), p.240-247</ispartof><rights>2011 The Authors Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation</rights><rights>2015 INIST-CNRS</rights><rights>2011 The Authors Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25353671$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22092012$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/149896$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>REINSFELT, B.</creatorcontrib><creatorcontrib>WESTERLIND, A.</creatorcontrib><creatorcontrib>IOANES, D.</creatorcontrib><creatorcontrib>ZETTERBERG, H.</creatorcontrib><creatorcontrib>FREDÉN-LINDQVIST, J.</creatorcontrib><creatorcontrib>RICKSTEN, S.-E.</creatorcontrib><title>Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
Recent studies have shown that transcatheter aortic valve implantation (TAVI) is associated with new foci of restricted diffusion on cerebral magnetic resonance imaging suggestive of cerebral microembolism. The aim of the present investigation was to quantify the cerebral embolic load and to evaluate during which phase of the TAVI procedure microembolism occurs. We also evaluated the association between the cerebral embolic load and post‐procedural release of S100B, a serological marker of cerebral injury.
Methods
In 21 patients, we described the extent and intra‐procedural distribution of microemboli during the TAVI procedure using the transcranial Doppler technique. S100B, a marker of astroglial injury, was measured for 24 h after the procedure, and the area under the curve (AUC24h) relating S100B to time was calculated.
Results
During the TAVI procedure, a mean of 282 ± 169 emboli was detected, 37% occurred during manipulation of the aortic arch/root/valve by guide wires and catheters, 22% occurred immediately after balloon dilatation of the native valve and 41% occurred during frame expansion of the valve prosthesis. S100B increased in all patients with a peak at 1 h after the procedure and returned to baseline after 4 h. There was a positive correlation between the total amount of cerebral microemboli and the AUC24h for S100B (r = 0.68, P < 0.001). None of the patients developed neurological impairment.
Conclusion
TAVI is associated with a substantial amount of cerebral microemboli. The microembolic load correlates to the degree of post‐procedural release of a marker of cerebral injury.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anestesi och intensivvård</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthesiology and Intensive Care</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Valve - surgery</subject><subject>Area Under Curve</subject><subject>Biological and medical sciences</subject><subject>Biomarkers</subject><subject>Brain Injuries - diagnostic imaging</subject><subject>Brain Injuries - etiology</subject><subject>Cardiac Catheterization</subject><subject>Cerebral Arteries - diagnostic imaging</subject><subject>Female</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Humans</subject><subject>Intracranial Embolism - diagnostic imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Monitoring, Intraoperative</subject><subject>S100 Proteins - blood</subject><subject>Stroke Volume - physiology</subject><subject>Ultrasonography, Doppler, Transcranial</subject><issn>0001-5172</issn><issn>1399-6576</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNp9kk1v1DAQhiMEotvCX0C-ILgk-CNO4gOHVaEFURUhFiFxsRxnsnjJF3ay3b3yy5l0l-0NH_z5zCvPzBtFhNGE4XizSZhQKs5kniWcMpZQLjOR7B5Fi9PD42hBKWWxZDk_i85D2OBRpEo9jc44pwrj-CL6s_KmCxYnZxryrh-GBjxpnfU9tGXfOEuCW3emCcR0FQngp5a0xv9CCraugs4C6WtSeuM64rrN5Pekmrzr1mS8lzbjTxiRNr0fUW1rmi0Q1w6N6UYzur57Fj2pUR-eH9eL6NvV-9Xlh_jm8_XHy-VN7FIqRFxIxXmZ2TQri0qUFlhGoa5lntPCCrBMVHVdY14grbWmZnWupICUc6OMFEpcRPFBN9zBMJV68A4T2eveOL2eBo1X60kH0CxVhcqQf3XgB9__niCMunXBQoMfh34KWrGMpbngEsnX_yUZ54ylnKUFoi-O6FS2UJ0-8a8jCLw8AgZr19RYQ-vCAyeFFFnOkHt74O5cA_vTO6N6doje6NkIejaCnh2i7x2id3q5_DrvHqrhwgi7Uzx2Vme5yKX-fnutf3y5XeH-E4r9BeMRwLs</recordid><startdate>201202</startdate><enddate>201202</enddate><creator>REINSFELT, B.</creator><creator>WESTERLIND, A.</creator><creator>IOANES, D.</creator><creator>ZETTERBERG, H.</creator><creator>FREDÉN-LINDQVIST, J.</creator><creator>RICKSTEN, S.-E.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QO</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>F1U</scope></search><sort><creationdate>201202</creationdate><title>Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation</title><author>REINSFELT, B. ; WESTERLIND, A. ; IOANES, D. ; ZETTERBERG, H. ; FREDÉN-LINDQVIST, J. ; RICKSTEN, S.-E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-i4033-85922b6c46b8d3bce160eff57708c3ec13dfff092e5cccaf1f7953e422a9a5393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anestesi och intensivvård</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology and Intensive Care</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Valve - surgery</topic><topic>Area Under Curve</topic><topic>Biological and medical sciences</topic><topic>Biomarkers</topic><topic>Brain Injuries - diagnostic imaging</topic><topic>Brain Injuries - etiology</topic><topic>Cardiac Catheterization</topic><topic>Cerebral Arteries - diagnostic imaging</topic><topic>Female</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Humans</topic><topic>Intracranial Embolism - diagnostic imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Monitoring, Intraoperative</topic><topic>S100 Proteins - blood</topic><topic>Stroke Volume - physiology</topic><topic>Ultrasonography, Doppler, Transcranial</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>REINSFELT, B.</creatorcontrib><creatorcontrib>WESTERLIND, A.</creatorcontrib><creatorcontrib>IOANES, D.</creatorcontrib><creatorcontrib>ZETTERBERG, H.</creatorcontrib><creatorcontrib>FREDÉN-LINDQVIST, J.</creatorcontrib><creatorcontrib>RICKSTEN, S.-E.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Biotechnology Research Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Göteborgs universitet</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>REINSFELT, B.</au><au>WESTERLIND, A.</au><au>IOANES, D.</au><au>ZETTERBERG, H.</au><au>FREDÉN-LINDQVIST, J.</au><au>RICKSTEN, S.-E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2012-02</date><risdate>2012</risdate><volume>56</volume><issue>2</issue><spage>240</spage><epage>247</epage><pages>240-247</pages><issn>0001-5172</issn><issn>1399-6576</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background
Recent studies have shown that transcatheter aortic valve implantation (TAVI) is associated with new foci of restricted diffusion on cerebral magnetic resonance imaging suggestive of cerebral microembolism. The aim of the present investigation was to quantify the cerebral embolic load and to evaluate during which phase of the TAVI procedure microembolism occurs. We also evaluated the association between the cerebral embolic load and post‐procedural release of S100B, a serological marker of cerebral injury.
Methods
In 21 patients, we described the extent and intra‐procedural distribution of microemboli during the TAVI procedure using the transcranial Doppler technique. S100B, a marker of astroglial injury, was measured for 24 h after the procedure, and the area under the curve (AUC24h) relating S100B to time was calculated.
Results
During the TAVI procedure, a mean of 282 ± 169 emboli was detected, 37% occurred during manipulation of the aortic arch/root/valve by guide wires and catheters, 22% occurred immediately after balloon dilatation of the native valve and 41% occurred during frame expansion of the valve prosthesis. S100B increased in all patients with a peak at 1 h after the procedure and returned to baseline after 4 h. There was a positive correlation between the total amount of cerebral microemboli and the AUC24h for S100B (r = 0.68, P < 0.001). None of the patients developed neurological impairment.
Conclusion
TAVI is associated with a substantial amount of cerebral microemboli. The microembolic load correlates to the degree of post‐procedural release of a marker of cerebral injury.</abstract><cop>Oxford</cop><pub>Blackwell Publishing Ltd</pub><pmid>22092012</pmid><doi>10.1111/j.1399-6576.2011.02563.x</doi><tpages>8</tpages></addata></record> |
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| ispartof | Acta anaesthesiologica Scandinavica, 2012-02, Vol.56 (2), p.240-247 |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Aged Aged, 80 and over Anestesi och intensivvård Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology and Intensive Care Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - surgery Aortic Valve - surgery Area Under Curve Biological and medical sciences Biomarkers Brain Injuries - diagnostic imaging Brain Injuries - etiology Cardiac Catheterization Cerebral Arteries - diagnostic imaging Female Heart Valve Prosthesis Implantation - adverse effects Humans Intracranial Embolism - diagnostic imaging Male Medical sciences Monitoring, Intraoperative S100 Proteins - blood Stroke Volume - physiology Ultrasonography, Doppler, Transcranial |
| title | Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation |
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