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Updated: Oct 6, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Asymptomatic Stroke in the Setting of Percutaneous Non-Coronary Intervention Procedures
Giovanni Ciccarelli1, Francesca Renon1, Renato Bianchi1
1Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy.
Insights
Less-invasive cardiovascular procedures improve survival but can cause silent brain lesions. Further evaluation is needed to understand the neurological impact of these treatments in frail patients.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Cardiovascular diseases (CVDs) affect more elderly patients with comorbidities.
- Standard treatments are often unsuitable for frail patients due to high surgical risk.
- Less-invasive procedures like TAVI and MitraClip offer alternatives for high-risk patients.
Purpose of the Study:
- To evaluate the neurological impact of novel less-invasive cardiovascular procedures.
- To investigate the occurrence of silent ischemic brain lesions after these interventions.
Main Methods:
- Review of studies on less-invasive cardiovascular procedures (TAVI, MitraClip, LAA occlusion).
- Analysis of peri-procedural stroke risk and silent brain lesion incidence.
- Assessment of potential neurological consequences.
Main Results:
- Less-invasive procedures are effective and safe alternatives to conventional surgery.
- Symptomatic stroke is a rare complication.
- A high incidence of silent ischemic brain lesions is observed, potentially impacting neurological function.
Conclusions:
- While less-invasive cardiovascular procedures offer significant benefits, silent brain damage is a notable concern.
- The long-term neurological consequences of these silent lesions require systematic evaluation.
- Further research is essential to understand and mitigate the neurological risks associated with these advanced treatments.
Abstract:
Advancements in clinical management, pharmacological therapy and interventional procedures have strongly improved the survival rate for cardiovascular diseases (CVDs). Nevertheless, the patients affected by CVDs are more often elderly and present several comorbidities such as atrial fibrillation, valvular heart disease, heart failure, and chronic coronary syndrome. Standard treatments are frequently not available for "frail patients", in particular due to high surgical risk or drug interaction. In the past decades, novel less-invasive procedures such as transcatheter aortic valve implantation (TAVI), MitraClip or left atrial appendage occlusion have been proposed to treat CVD patients who are not candidates for standard procedures. These procedures have been confirmed to be effective and safe compared to conventional surgery, and symptomatic thromboembolic stroke represents a rare complication. However, while the peri-procedural risk of symptomatic stroke is low, several studies highlight the presence of a high number of silent ischemic brain lesions occurring mainly in areas with a low clinical impact. The silent brain damage could cause neuropsychological deficits or worse, a preexisting dementia, suggesting the need to systematically evaluate the impact of these procedures on neurological function.
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