Rodrigo Bagur1, MD, PhD; Luciano A. Sposato2, MD, MBA, FRCPC
1. Interventional Cardiology, Division of Cardiology, London Health Sciences Centre, Western University, London, ON, Canada; 2. Department of Clinical Neurological Sciences, Stroke, Dementia & Heart Disease Laboratory, London Health Sciences Centre, Western University, London, ON, Canada
Cerebrovascular accidents (CVA), mainly stroke, are still one of the Achilles’ Heels of transcatheter aortic valve implantation (TAVI) procedures; however, clinically evident strokes are not the only concern. TAVI procedures have also been associated with covert cerebral emboli captured on transcranial Doppler as high-intensity transient signals (HITS) and ultimately defined as silent brain infarcts, as documented on diffusion-weighted imaging magnetic resonance imaging (DWI-MRI)1,2. Notably, the incidence of silent brain infarcts is very much higher (up to 90%)1 than that of clinically evident strokes, which ranges from 0%3 to 2.3-2.5% at 30 days4.
The risk of periprocedural cerebrovascular complications in patients ...