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. 2023 Nov 30;3(1):101180.
doi: 10.1016/j.jscai.2023.101180. eCollection 2024 Jan.

Prevalence of Neurovascular Microemboli After Transcatheter Aortic Valve Replacement

Navneet Sharma  1 , Ryan F Heslin  1 , Saadat U Aleem  1 , John Medamana  2 , Leyla Gasimli-Gamache  2 , Jeanwoo Yoo  2 , Varun Bhasin  2 , Peter J Avvento  2 , Jose Wiley  3 , Thomas V Billfinger  4 , Henry J Tannous  4 , Puja B Parikh  1 , Smadar Kort  1 , Nicos Labropoulos  3   5 , George D Dangas  6 , John P Reilly  1 , Robert T Pyo  1
Affiliations

Prevalence of Neurovascular Microemboli After Transcatheter Aortic Valve Replacement

Navneet Sharma et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Neurolotic sequelae after transcatheter aortic valve replacement (TAVR) can cause significant morbidity and mortality. Transcranial Doppler (TCD) imaging can show real-time high intensity transient signals (HITS), which reflect active microembolization. Although it is well known that intraprocedural microembolism occurs, it is not known if this embolic phenomenon continues in the postprocedural period. We investigated whether microemboli occur post-TAVR and whether we could determine any clinical, procedural, or echocardiographic predictors.

Methods: We evaluated HITS in 51 consecutive patients undergoing unprotected TAVR with low-, intermediate-, or high-risk Society of Thoracic Surgeons score. Patients were excluded if they did not have temporal windows for insonation of the middle cerebral artery or if they were not willing to participate. Primary outcomes of HITS 24 hours post-TAVR were observed using a Philips iU22 TCD. TCD was performed at 3 time points (pre-, peri-, and post-TAVR) for each patient, before, during, and 24 hours postprocedure.

Results: While no HITS were detected in any of the patients preoperatively, all patients had HITS during the procedure. Interestingly, 56.8% had HITS 24 hours post-TAVR. One patient with HITS post-TAVR had a stroke 48 hours after TAVR.

Conclusion: We observed a high prevalence of microemboli 24 hours post-TAVR. None of the predictors for intraprocedural microembolism seemed to play an important role for post-TAVR microemboli.

Keywords: distal embolic protection; high intensity transient signals; stroke; transcatheter aortic valve implantation; transcranial Doppler.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Patient flow diagram: 56 patients (pts) were studied. Two patients were excluded because of poor transcranial Doppler windows. Three patients with good windows withdrew consent. Fifty-one patients were included in the final analysis.
Figure 2
Figure 2
Schematic representation of transcranial Doppler (TCD): middle cerebral artery was insonated using Philips iU22. Each patient was scanned at 3 different time points: before, during, and 24 hours after TAVR. HITS were defined as unidirectional transient signals (duration <300 ms) that have an amplitude >3 decibels higher than the background blood flow in the Doppler velocity spectrum. HITS are highlighted with red arrows. HITS, high-intensity transient signals; TAVR, transcatheter aortic valve replacement.
Central Illustration
Central Illustration
No patients had pre-transcatheter aortic valve replacement high-intensity transient signals (HITS). All patients with intra-TAVR transcranial Doppler had evidence of HITS. Of the patients, 56.8% continued to have HITS at 24 hours post-TAVR.
See this image and copyright information in PMC

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