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Observational Study
. 2023 Feb 7;12(3):e8189.
doi: 10.1161/JAHA.122.027284. Epub 2023 Feb 3.

New Cerebral Microbleeds After Catheter-Based Structural Heart Interventions: An Exploratory Analysis

Tim Bastian Braemswig  1   2   3   4 , Madeleine Kusserow  5   6 , Barbara Bellmann  7   8 , Frederik Beckhoff  8 , Markus Reinthaler  8   9   10 , Regina von Rennenberg  1   3   11 , Hebun Erdur  1   3 , Jan F Scheitz  1   2   3   4 , Ivana Galinovic  3 , Kersten Villringer  3 , David M Leistner  2   4   8   12   13 , Heinrich J Audebert  1   3 , Matthias Endres  1   3   4   11   14 , Ulf Landmesser  2   4   8   10 , Karl Georg Haeusler  15 , Jochen B Fiebach  3 , Alexander Lauten  8   16 , Andreas Rillig  8   17 , Christian H Nolte  1   2   3   4   11
Affiliations
Observational Study

New Cerebral Microbleeds After Catheter-Based Structural Heart Interventions: An Exploratory Analysis

Tim Bastian Braemswig et al. J Am Heart Assoc. .

Abstract

Background Cerebral microbleeds (CMBs) are increasingly recognized as "covert" brain lesions indicating increased risk of future neurological events. However, data on CMBs in patients undergoing catheter-based structural heart interventions are scarce. Therefore, we assessed occurrence and predictors of new CMBs in patients undergoing catheter-based left atrial appendage closure and percutaneous mitral valve repair using the MitraClip System. Methods and Results We conducted an exploratory analysis using data derived from 2 prospective, observational studies. Eligible patients underwent cerebral magnetic resonance imaging (3 Tesla) examinations and cognitive tests (using the Montreal Cognitive Assessment) before and after catheter-based left atrial appendage closure and percutaneous mitral valve repair. Forty-seven patients (53% men; median age, 77 years) were included. New CMBs occurred in 17 of 47 patients (36%) following catheter-based structural heart interventions. Occurrences of new CMBs did not differ significantly between patients undergoing catheter-based left atrial appendage closure and percutaneous mitral valve repair (7/25 versus 10/22; P=0.348). In univariable analysis, longer procedure time was significantly associated with new CMBs. Adjustment for heparin attenuated this association (adjusted odds ratio [per 30 minutes]: 1.77 [95% CI, 0.92-3.83]; P=0.090). Conclusions New CMBs occur in approximately one-third of patients after catheter-based left atrial appendage closure and percutaneous mitral valve repair using the MitraClip System. Our data suggest that longer duration of the procedure may be a risk factor for new CMBs. Future studies in larger populations are needed to further investigate their clinical relevance. Clinical Trial Registration German Clinical Trials Register: DRKS00010300 (https://drks.de/search/en/trial/DRKS00010300); ClinicalTrials.gov : NCT03104556 (https://clinicaltrials.gov/ct2/show/NCT03104556?term=NCT03104556&draw=2&rank=1).

Keywords: catheter‐based structural heart interventions; cerebral microbleeds; left atrial appendage closure; mitral valve repair (MVR) using the MitraClip System.

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Figures

Figure 1
Figure 1. Flowchart of the study population.
LAAC indicates left atrial appendage closure; and MRI, magnetic resonance imaging.
Figure 2
Figure 2. New cerebral microbleed after catheter‐based structural heart intervention.
MRI indicates magnetic resonance imaging.
See this image and copyright information in PMC

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