Asymptomatic Stroke in the Setting of Percutaneous Non-Coronary Intervention Procedures.
Giovanni CiccarelliFrancesca RenonRenato BianchiDonato TartaglioneMaurizio Cappelli BigazziFrancesco LoffredoPaolo GolinoGiovanni CimminoPublished in: Medicina (Kaunas, Lithuania) (2021)
Advancements in clinical management, pharmacological therapy and interventional procedures have strongly improved the survival rate for cardiovascular diseases (CVDs). Nevertheless, the patients affected by CVDs are more often elderly and present several comorbidities such as atrial fibrillation, valvular heart disease, heart failure, and chronic coronary syndrome. Standard treatments are frequently not available for "frail patients", in particular due to high surgical risk or drug interaction. In the past decades, novel less-invasive procedures such as transcatheter aortic valve implantation (TAVI), MitraClip or left atrial appendage occlusion have been proposed to treat CVD patients who are not candidates for standard procedures. These procedures have been confirmed to be effective and safe compared to conventional surgery, and symptomatic thromboembolic stroke represents a rare complication. However, while the peri-procedural risk of symptomatic stroke is low, several studies highlight the presence of a high number of silent ischemic brain lesions occurring mainly in areas with a low clinical impact. The silent brain damage could cause neuropsychological deficits or worse, a preexisting dementia, suggesting the need to systematically evaluate the impact of these procedures on neurological function.
Keyphrases
- atrial fibrillation
- left atrial appendage
- transcatheter aortic valve implantation
- heart failure
- ejection fraction
- aortic stenosis
- end stage renal disease
- catheter ablation
- oral anticoagulants
- left atrial
- aortic valve
- coronary artery disease
- cerebral ischemia
- chronic kidney disease
- newly diagnosed
- coronary artery
- minimally invasive
- transcatheter aortic valve replacement
- mild cognitive impairment
- direct oral anticoagulants
- type diabetes
- oxidative stress
- resting state
- aortic valve replacement
- white matter
- percutaneous coronary intervention
- blood brain barrier
- metabolic syndrome
- stem cells
- patient reported outcomes
- middle aged
- multiple sclerosis
- brain injury
- pulmonary hypertension
- cardiovascular events
- cognitive impairment
- acute coronary syndrome
- ultrasound guided
- adverse drug
- free survival