Incidence of and Risk Factors for Stroke and Cerebral Microembolism after Transcatheter Aortic Valve Replacement: Insights from Diffusion-Weighted Magnetic Resonance Imaging of the Brain
14
Issued Date
2025-05-01
Resource Type
ISSN
01252208
Scopus ID
2-s2.0-105007292067
Journal Title
Journal of the Medical Association of Thailand
Volume
108
Issue
5
Start Page
420
End Page
430
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand Vol.108 No.5 (2025) , 420-430
Suggested Citation
Luangphiphat W., Udol K., Aramsareewong T., Jeamanukoolkit A., Preeyanont P., Tassanawiwat W., Sukitpunyaroj D., Muangsillapasart V., Sirisreetreerux N., Wongsinkongman C., Hirunpattarasilp C., Senngam K., Choolam A., Tweeatsani N. Incidence of and Risk Factors for Stroke and Cerebral Microembolism after Transcatheter Aortic Valve Replacement: Insights from Diffusion-Weighted Magnetic Resonance Imaging of the Brain. Journal of the Medical Association of Thailand Vol.108 No.5 (2025) , 420-430. 430. doi:10.35755/jmedassocthai.2025.5.420-430-02878 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110631
Title
Incidence of and Risk Factors for Stroke and Cerebral Microembolism after Transcatheter Aortic Valve Replacement: Insights from Diffusion-Weighted Magnetic Resonance Imaging of the Brain
Author's Affiliation
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an established treatment for severe symptomatic aortic stenosis, but it carries a risk of cerebrovascular events, including clinical ischemic stroke, transient ischemic attack (TIA), and silent cerebral ischemic lesions (SCILs). The detection of these lesions using advanced imaging modalities, such as diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain, provides valuable insights into procedural and patient-related factors contributing to their occurrence. Objective: To evaluate the incidence of and risk factors for stroke, TIA, and SCILs in patients undergoing TAVR. Materials and Methods: A prospective cohort study was conducted on patients with severe symptomatic aortic stenosis undergoing TAVR at a single center. Cerebral ischemia was assessed using DW-MRI of the brain within seven to fourteen days and three to six months post-procedure. Baseline demographics, procedural details, and outcomes were analyzed to identify predictors of SCILs and stroke. Results: Of the 48 patients included, SCILs were detected in 91.67% using DW-MRI of the brain, with a mean lesion size of 4.01±2.58 mm. Transient clinical stroke occurred in one patient (2.08%), while a permanent clinical stroke was reported in two patients (4.17%). Lesions predominantly involved the middle cerebral artery territories at 50.81%, consistent with embolic events. Multivariate analysis identified valve dislodgement as a significant predictor of SCILs (p<0.001). Procedural factors such as rapid ventricular pacing and post-dilatation were not associated with SCILs. Conclusion: The present study highlights a high incidence of SCILs following TAVR, driven by procedural and patient-specific factors. Further research is needed to assess the long-term clinical implications of SCILs.