Cerebral microembolism during cardiac catheterization and risk of acute brain injury: a prospective diffusion-weighted magnetic resonance imaging study
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Published on: August 14, 2019
Michèle Hamon1, Sophie Gomes, Catherine Oppenheim
1Department of Neuroradiology, University Hospital of Caen, Normandy, France. hamon-m@chu-caen.fr
Background And Purpose:
Cerebral microembolism detected by transcranial Doppler occurs systematically during cardiac catheterization, but its clinical relevance remains unknown. Studies suggest that asymptomatic embolic cerebral infarction detectable by diffusion-weighted (DW) MRI might exist after percutaneous cardiac interventions, especially after retrograde catheterization of the aortic valve in patients with valvular aortic stenosis, with a frequency as high as 22% of cases. We investigated the incidence of new ischemic lesions on serial cerebral DW MRI after cardiac catheterization.
Methods:
This prospective study involved 46 patients with severe aortic valve stenosis. To assess the occurrence of cerebral infarction, all patients underwent cerebral DW MRI and neurological assessment within 24 hours before and 48 hours after cardiac catheterization and retrograde catheterization of the aortic valve. A subgroup was monitored by transcranial power M-mode Doppler during cardiac catheterization to observe cerebral blood flow and track emboli.
Results:
One patient had a focal diffusion abnormality on DW MRI before cardiac catheterization. After catheterization, we detected only 1 additional acute cerebral diffusion abnormality in a single case (2.2%), although cerebral microemboli were detected in all transcranial Doppler-monitored patients during cardiac catheterization, as expected. All patients remained asymptomatic. Based on these results a mid-point incidence of 5.9% (95% CI, 0.01 to 12.5) for abnormalities on DW MRI in asymptomatic cardiac catheterization patients in our center can be assigned.
Conclusions:
Unsuspected cerebral infarctions can be detected by DW MRI after cardiac catheterization, but this phenomenon remains unfrequent in our series. Further studies are needed to identify factors explaining the discrepancy between these results and those of previous studies.
Insights
Cerebral microemboli are common during cardiac catheterization, but new ischemic lesions on diffusion-weighted MRI are infrequent in patients with aortic stenosis. This study found a low incidence of asymptomatic cerebral infarction after the procedure.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Cerebral microembolism is a known complication of cardiac catheterization.
- Previous studies suggest a high incidence of asymptomatic cerebral infarction after percutaneous cardiac interventions, particularly in patients with aortic stenosis.
Purpose of the Study:
- To investigate the incidence of new ischemic lesions on serial cerebral diffusion-weighted (DW) MRI after cardiac catheterization in patients with severe aortic valve stenosis.
Main Methods:
- Prospective study of 46 patients with severe aortic valve stenosis.
- Cerebral DW MRI and neurological assessments were performed before and after cardiac catheterization.
- Transcranial Doppler monitoring was used in a subgroup to detect cerebral microemboli.
Main Results:
- Only one patient (2.2%) showed a new acute cerebral diffusion abnormality on DW MRI post-catheterization.
- Cerebral microemboli were detected in all transcranial Doppler-monitored patients.
- The midpoint incidence of DW MRI abnormalities was estimated at 5.9%.
Conclusions:
- New ischemic lesions on DW MRI after cardiac catheterization are infrequent in this series of patients with aortic stenosis.
- Further research is needed to understand the discrepancy with previous findings and identify risk factors.
