Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
JACC Cardiovasc Interv. 2020 Jun 8;13(11):1291-1300. doi: 10.1016/j.jcin.2020.03.004. Epub 2020 May 13.
The aim of this study was to assess the characteristics, predictors, evolution, and neurocognitive effects of silent cerebral ischemic lesions (SCILs).
Most patients undergoing transcatheter aortic valve replacement (TAVR) develop SCILs detectable on magnetic resonance imaging (MRI). The natural history and clinical relevance of SCILs are not well established.
Cerebral MRI was performed within 7 days before TAVR to assess baseline status and age-related white matter change score. MRI was repeated post-operatively to assess the occurrence, location, number, and dimensions of SCILs. Patients developing SCILs underwent a third MRI examination at 3- to 5-month follow-up. A neurocognitive evaluation was performed before TAVR, at discharge, and at 3-month follow-up.
Of the 117 patients enrolled, 96 underwent post-procedural MRI; SCILs were observed in 76% of patients, distributed in all vascular territories, with a median number of 2 lesions, a median diameter of 4.5 mm, and a median total volume of 140 mm. Independent predictors of SCIL occurrence were higher baseline age-related white matter change score and the use of self-expanding or mechanically expanded bioprostheses. Among 47 patients who underwent follow-up MRI, only 26.7% of post-procedural SCILs evolved into gliotic scar. SCIL occurrence was associated with a more pronounced transient neurocognitive decline early after TAVR and with lower recovery at follow-up.
SCILs occur in the vast majority of patients undergoing TAVR and are predicted by more diffuse white matter damage at baseline and by the use of non-balloon-expandable prostheses. Although most SCILs disappear within months, their occurrence has a limited but significant impact on neurocognitive function.
本研究旨在评估无症状性脑缺血性病变（SCILs）的特征、预测因素、演变过程和神经认知影响。
大多数行经导管主动脉瓣置换术（TAVR）的患者在磁共振成像（MRI）上可检测到 SCILs。SCILs 的自然史和临床相关性尚未得到充分证实。
在 TAVR 前 7 天内行脑部 MRI 检查，以评估基线状态和年龄相关性白质改变评分。术后重复 MRI 检查以评估 SCILs 的发生、位置、数量和大小。出现 SCILs 的患者在 3 至 5 个月的随访时进行第三次 MRI 检查。在 TAVR 前、出院时和 3 个月随访时进行神经认知评估。
在纳入的 117 例患者中，96 例患者进行了术后 MRI 检查；76%的患者出现 SCILs，分布于所有血管区域，中位数数量为 2 个病变，中位数直径为 4.5mm，中位数总容积为 140mm。SCIL 发生的独立预测因素是较高的基线年龄相关性白质改变评分和使用自膨式或机械扩张生物假体。在 47 例接受随访 MRI 的患者中，仅 26.7%的术后 SCIL 发展为胶质瘢痕。SCIL 的发生与 TAVR 后早期更明显的短暂性神经认知下降以及随访时较低的恢复相关。
SCILs 在大多数接受 TAVR 的患者中发生，且在基线时弥散性白质损伤更严重和使用非球囊扩张假体的患者中更易发生。尽管大多数 SCILs 在数月内消失，但它们的发生对神经认知功能仍有一定但显著的影响。
