Author + information
- Michael Dwyer1,
- Axel Linke2,
- Carlye Kraemer3,
- Roseann White4,
- Ronald Lazar5,
- Samir Kapadia6,
- Susheel Kodali7,
- Thomas Engels8,
- Azin Parhizgar8,
- Roxana Mehran9,
- Raj Makkar10,
- Saif Anwaruddin11,
- Martin Leon12 and
- Robert Zivadinov13
- 1University at Buffalo, Buffalo, New York, United States
- 2University of Leipzig Heart Center, Leipzig, Germany
- 3NAMSA, Minneapolis, Minnesota, United States
- 4DCRI, Durham, North Carolina, United States
- 5University of Alabama at Birmingham, Birmingham, AL, Alabama, United States
- 6Heart and Vascular Institute, Cleveland, Ohio, United States
- 7New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 8Claret Medical, Santa Rosa, California, United States
- 9Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 10Cedars-Sinai Medical Center, Los Angeles, California, United States
- 11University of Pennsylvania, Philadelphia, Pennsylvania, United States
- 12Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 13Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, New York, United States
Neurological events and brain infarction remain a concern after transcatheter aortic valve replacement (TAVR). While Cerebral Embolic Protection (CEP) devices provide meaningful protection, recent trials still showed substantial variability in individual outcomes. There remains a strong need to identify individual patient outcome predictors. Pre-existing white matter disease (T2-FLAIR positive lesion volume) may reflect overall susceptibility to cerebrovascular insults. In this context, we set out to determine whether pre-procedural T2-FLAIR cerebral lesions are predictive of new brain infarction and/or neurological events after TAVR.
Data from the SENTINEL trial was analyzed post hoc. Subjects were split into two groups, based on median baseline T2-FLAIR lesion volume, and 30 day MACCE rates, stroke rates, and 2-7day post-TAVR new ischemic lesion (DWI) volumes were compared between groups.
A total of 228 subjects were included in the analysis, with a mean age of 83.1 (±7.8). MACCE and stroke rates for the above-median T2-lesion volume group were numerically higher than the below-median group (10.5% vs. 5.3% for MACCE and 8.8% vs. 4.4% for stroke), but the differences did not reach significance. In contrast, median post-TAVR new ischemic lesion volume was more than twice as large in those with high baseline T2 lesion volume (479.9 mm3 vs. 197.8 mm3), and the difference was highly significant (p<0.001).
Pre-existing T2- FLAIR lesion burden strongly predicts new procedure-related DWI lesion volume in TAVR, and should be included as a covariate when using that endpoint in studies. Its relationship with MACCE and stroke rates is less clear, and needs further study in larger cohorts.
ENDOVASCULAR: Stroke and Stroke Prevention