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Multiple cerebral emboli following dislocation and retraction of a partially deployed CoreValve prosthesis during

Timothy A Fairbairn1, John P Greenwood, Daniel J Blackman

  • 1Multidisciplinary Cardiovascular Research Centres & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, United Kingdom.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 29, 2011
PubMed

Insights

Transcatheter aortic valve implantation improves survival for high-risk patients with severe aortic stenosis. However, stroke risk, often from dislodged atheroma, remains a concern, as illustrated by two case studies.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Medical Device Technology

Background:

  • Transcatheter aortic valve implantation (TAVI) offers improved survival for high-operative risk patients with severe aortic stenosis compared to medical therapy.
  • Registry data and clinical trials indicate a 3-5% risk of stroke post-TAVI.

Observation:

  • Cerebral diffusion-weighted MRI suggests TAVI-associated strokes result from small embolic infarcts, likely from dislodged aortic atheroma.
  • The incidence of these subclinical infarcts may exceed clinically apparent strokes.
  • Valve repositioning maneuvers during TAVI may increase embolic risk.

Findings:

  • This report details two cases of cerebral infarction following TAVI with the Medtronic CoreValve prosthesis.
  • Both clinically evident and "silent" cerebral infarcts were observed in these patients.
  • The findings highlight potential embolic complications associated with TAVI device manipulation.

Implications:

  • Understanding the mechanisms of TAVI-related stroke is crucial for developing preventative strategies.
  • Further research is needed to mitigate the risk of cerebral embolism during TAVI procedures.
  • These cases underscore the importance of neuroprotection during TAVI in high-risk populations.

Keywords:
cath/interventioncomplications adultimaging (CT/MR)valvular heart disease

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