Department of Medicine/Cardiology, University of Bonn, Bonn, Germany.
J Am Coll Cardiol. 2010 Apr 6;55(14):1427-32. doi: 10.1016/j.jacc.2009.12.026. Epub 2010 Feb 24.
The aim of this study was prospective investigation of silent and clinically apparent cerebral embolic events and neurological impairment after transfemoral aortic valve implantation (TAVI).
TAVI is a novel therapeutic approach for multimorbid patients with severe aortic stenosis. We investigated peri-interventional cerebral embolism with diffusion-weighted magnetic resonance imaging (DW-MRI) and its relationship to clinical and serologic parameters of brain injury.
Cerebral DW-MRI was performed before, directly, and 3 months after TAVI with the current third-generation self-expanding CoreValve (Medtronic, Minneapolis, Minnesota) prosthesis. At the timepoints of the serial MRI studies, focal neurological impairment was assessed according to the National Institutes of Health Stroke Scale (NIHSS), and serum concentration of neuron-specific enolase (NSE), a marker of the volume of brain tissue involved in an ischemic event, were determined.
Thirty patients were enrolled; 22 completed the imaging protocol. Three patients (10%) had new neurological findings after TAVI, of whom only 1 (3.6%) had a permanent neurological impairment. Of the 22 TAVI patients with complete imaging data, 16 (72.7%) had 75 new cerebral lesions after TAVI presumed to be embolic. The NIHSS and NSE were not correlated with DW-MRI lesions.
The incidence of clinically silent peri-interventional cerebral embolic lesions after TAVI is high. However, in this cohort of 30 patients, the incidence of persistent neurological impairment was low. (Incidence and Severity of Silent and Apparent Cerebral Embolism After Conventional and Minimal-invasive Transfemoral Aortic Valve Replacement; NCT00883285).
本研究旨在前瞻性观察经股动脉主动脉瓣置换术（TAVI）后无症状和临床明显的脑栓塞事件及神经功能障碍。
TAVI 是一种治疗严重主动脉瓣狭窄合并多种合并症患者的新方法。我们通过弥散加权磁共振成像（DW-MRI）研究了围手术期脑栓塞，并研究了其与脑损伤的临床和血清学参数的关系。
使用第三代自膨式 CoreValve（美敦力，明尼苏达州明尼阿波利斯市）人工瓣膜，在 TAVI 术前、即刻和术后 3 个月对患者行脑 DW-MRI 检查。在连续 MRI 研究的各个时间点，根据美国国立卫生研究院卒中量表（NIHSS）评估局灶性神经功能障碍，测定神经元特异性烯醇化酶（NSE）的血清浓度，该指标是参与缺血事件的脑组织容积的标志物。
共纳入 30 例患者，其中 22 例完成了影像学检查。3 例患者（10%）TAVI 后出现新的神经学表现，其中仅 1 例（3.6%）有永久性神经功能障碍。22 例完成影像学检查的 TAVI 患者中，16 例（72.7%）在 TAVI 后有 75 个新的脑损伤，推测为栓塞性病变。NIHSS 和 NSE 与 DW-MRI 病变无相关性。
TAVI 后无症状性围手术期脑栓塞的发生率较高。然而，在本研究的 30 例患者中，持续性神经功能障碍的发生率较低。（常规和微创经股动脉主动脉瓣置换术的静默和明显脑栓塞的发生率和严重程度；NCT00883285）。
