NEW YORK (Reuters Health), Apr 12 - Silent cerebral embolism is common after transfemoral aortic valve implantation, German researchers report in the April 6 Journal of the American College of Cardiology.
"With this study, we wanted to raise awareness of potential complications," lead author Dr. Alexander Ghanem from the University of Bonn, Germany, told Reuters Health by e-mail.
Dr. Ghanem and colleagues investigated the incidence of silent and apparent cerebral emboli in 22 patients (mean age, 79 years) after transfemoral aortic valve implantation. Preoperatively, diffusion-weighted magnetic resonance imaging (MRI) showed that all patients had brain atrophy and hyperintense white matter lesions, but none had any acute ischemic lesions.
Within three days after receiving the new aortic valve, 16 patients (72.7%) had a total of 75 new lesions. Thirty-one of the new lesions (41.3%) were in patients with lacunar defects and old infarcts.
At three months after transfemoral aortic valve placement, three of the 16 patients (18.8%) showed focal signal increases in the region corresponding to the original lesion, indicating the presence of infarcted brain tissue.
Only three patients reported neurological symptoms, including one who developed persistent left-sided hemiparesis. This was the only patient to have significant neurological deficits at three months.
Levels of neuron-specific enolase, a marker of the volume of brain tissue involved in an ischemic event, did not correlate with new lesions.
The prevalence of cerebrovascular and peripheral artery disease and aortic atheroma was slightly higher in patients with embolic lesions, but procedural duration did not differ between patients with and without embolic events.
"The initial idea was to identify independent risk factors for cerebral embolism" related to transfemoral aortic valve implantation, Dr. Ghanem said. "However, the patient number is limited and does not allow a multivariate analysis." He and his colleagues had originally enrolled 30 patients, but only 22 completed the imaging protocol.
The knowledge about silent emboli related to transfemoral aortic valve implantation "could raise awareness for the careful management of peri-interventional anticoagulation," the researchers conclude.
By Will Boggs, M.D.
J Am Coll Cardiol 2010;55:1427-1432.
Last Updated: 2010-04-09 15:12:09 -0400 (Reuters Health)
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![Overview of the study design. (A) The fully automated deep learning framework was developed to estimate body composition (BC) (defined as subcutaneous adipose tissue [SAT] in liters; visceral adipose tissue [VAT] in liters; skeletal muscle [SM] in liters; SM fat fraction [SMFF] as a percentage; and intramuscular adipose tissue [IMAT] in deciliters) from MRI. The fully automated framework comprised one model (model 1) to quantify different BC measures (SAT, VAT, SM, SMFF, and IMAT) as three-dimensional (3D) measures from whole-body MRI scans. The second model (model 2) was trained to identify standardized anatomic landmarks along the craniocaudal body axis (z coordinate field), which allowed for subdividing the whole-body measures into different subregions typically examined on clinical routine MRI scans (chest, abdomen, and pelvis). (B) BC was quantified from whole-body MRI in over 66,000 individuals from two large population-based cohort studies, the UK Biobank (UKB) (36,317 individuals) and the German National Cohort (NAKO) (30,291 individuals). Bar graphs show age distribution by sex and cohort. BMI = body mass index. (C) After the performance assessment of the fully automated framework, the change in BC measures, distributions, and profiles across age decades were investigated. Age-, sex-, and height-adjusted body composition reference curves were calculated and made publicly available in a web-based z-score calculator (https://circ-ml.github.io).](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/05/body-comp.XgAjTfPj1W.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
