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A study published by the Journal of the American College of Cardiology suggests that Brain MRI along with Transfemoral Aortic-valve Implantation (TAVI) detects emboli that usually goes undetected.

For patients with high surgical risk, a TAVI device have to be approved by the FDA, but still, some surgeons are using this method instead of surgery, in low-risk patients.The CoreValve and Edwards Sapien TAVI devices are widely used in Europe.

The study was conducted by Dr Alexander Ghanem and colleagues of University of Bonn, Germany. They found that when compared to conventional MRI, the incidence of clinically silent cerebral embolic lesions on MRI images after TAVI was high, but the incidence of persistent neurological impairment was low.

Ghanem said, "The study raises awareness of potential cerebral embolism, which most often stays clinically silent. This end point is a sensitive surrogate parameter for future neuroprotective approaches." 

30 patients undergoing TAVI approach for the implantation of a CoreValve aortic-valve prosthesis were evaluated by Ghanem and his colleagues for the study. Out of them, 22 were evaluated with cerebral diffusion-weighted- MRI scans thrice - before, directly after and three months after - evaluating with TAVI. 

It was found that there were three patients with neurological impairment following the TAVI, and only one with a permanent neurological impairment. Around 75 lesions were found in 16 patients, where MRI scans were taken immediately after TAVI. 59 out of the 75 lesions were in the supratentorial region of the brain, which contains cerebrum and rest were in the infratentorial region, the part of the brain containing cerebellum. In 16 patients, MRI taken after three months of TAVI showed an infarcted tissue in the area of a lesion that had appeared in the scan right after TAVI.

According to the study, emboli appears on MRI scans of those patients who already had cerebral events and cerebrovascular disease, and the patients with the emboli had a tendency of having worse renal function.

Source : JACC

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