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Published on: March 15, 2022
Cerebral Embolic Risk in Coronary and Structural Heart Interventions: Clinical Evidence
Daniela Tirziu1, Haocheng Huang1, Helen Parise1
1Yale Cardiovascular Research Group, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Insights
Nearly 2 million patients undergo cardiac procedures annually in the US, with thousands at risk of stroke and over 330,000 facing ischemic brain injury. This highlights the significant risk of iatrogenic brain injury from these interventions.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Cardiac interventions, including surgical and transcatheter procedures, carry a risk of acute stroke and neurocognitive impairment.
- Transcatheter aortic valve replacement has increased focus on procedure-related neurologic injuries and the need for embolic protection.
- Rising numbers of cardiac procedures amplify concerns about iatrogenic brain injury, especially in high-risk populations.
Purpose of the Study:
- To review current estimates of iatrogenic cerebral embolization and ischemic infarction after cardiac interventions.
- To assess the incidence of brain injury following coronary artery disease, valvular, and other structural heart interventions.
- To underscore the significance of neurologic risks associated with increasing cardiac procedure volumes.
Main Methods:
- Review of existing literature and data on neurologic injury incidence.
- Analysis of estimates for iatrogenic cerebral embolization and ischemic infarction.
- Examination of data related to coronary artery disease, aortic/mitral valve stenosis, atrial fibrillation, left atrial appendage closure, and patent foramen ovale closure interventions.
Main Results:
- Approximately 2 million patients undergo cardiac interventions annually in the US.
- An estimated 8,000 patients are at risk of symptomatic stroke post-procedure.
- Over 330,000 patients (95% CI, 249,948-430,377) are at risk of ischemic brain injury.
Conclusions:
- The risk of iatrogenic cerebral embolism is significant due to the increasing use of cardiac procedures.
- Neurologic and cognitive assessments are crucial for managing patients undergoing these interventions.
- Appropriate risk mitigation strategies are necessary to address the potential for procedure-related brain injury.
Abstract:
Surgical and endovascular procedures for coronary and structural heart interventions carry a meaningful risk of acute stroke with greatly increased likelihood of disability and long-term neurocognitive sequelae. In the last decade, transcatheter aortic valve replacement procedures have focused our attention on a spectrum of procedure-related neurologic injuries that have led to various efforts to prevent ischemic injury with the use of embolic protection devices. As the number of patients undergoing surgical and transcatheter cardiac procedures in the United States continues to increase, the risk of iatrogenic brain injury is concerning, particularly in patient populations already at increased risk of thromboembolism and cognitive decline. In this study, we reviewed the current estimates of the incidence of iatrogenic cerebral embolization and ischemic infarction after surgical and percutaneous transcatheter interventions for coronary artery disease, stenotic aortic and mitral valves, atrial fibrillation, left atrial appendage and patent foramen ovale closure. Our findings show that every year in the United States, nearly 2 million patients undergo coronary and structural heart interventions, with approximately 8000 at risk of experiencing a symptomatic stroke and 330,225 (95% CI, 249,948-430,377) at the risk of ischemic brain injury after the procedure. Given the increased use of surgical and endovascular cardiac procedures in clinical practice, the risk of iatrogenic cerebral embolism is significant and demands careful consideration through neurologic and cognitive assessments and appropriate risk mitigation.
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