87. Microembolic and haemodynamic events underlying periprocedural neuroradiological findings and neurological complications of Transfemoral Aortic Valve Implantation (TAVI): A Transcranial Doppler study design

Abstract

Stroke and cognitive decline, due to periprocedural embolic and/or haemodynamic events, are the most feared neurological complications of Transfemoral Aortic Valve Implantation (TAVI). Transcranial Doppler (TCD) monitoring allows real time detection of such abnormalities, but their exact correlation with new-onset brain lesions and clinical findings has not been fully elucidated yet. Consecutive candidates to TAVI will be enrolled; patients with contraindications to MRI or inadequate transtemporal acoustic window will be excluded. Pre-procedurally, at discharge and at 3 months follow-up, neurological examination (through NIHSS, mRS), cognitive profile (through MMSE and MoCA test) and brain parenchyma status (through DWI and FLAIR sequences on MRI) will be assessed. During TAVI, a continuous TCD monitoring on middle cerebral arteries (with 2-MHz flat-probes) will be performed; a dedicated software for recording of hemodynamic changes and discrimination of microembolic events will be used, too. Off-line, TCD alterations will be analysed and the potential correlation with phase, neuroradiological and clinical findings will be evaluated. The study could shed new light into pathophysiology of neurological complications after TAVI, helping to assess the most dangerous phases of the procedure and suggesting potential technical modifications to increase its safety.