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Jain H, Goyal A, Khan AT, Khan NU, Jain J, Chopra S, Sulaiman SA, Reddy MM, Patel K, Khullar K, Daoud M, Sohail AH. Insights into calcific aortic valve stenosis: a comprehensive overview of the disease and advancing treatment strategies. Ann Med Surg (Lond) 2024; 86:3577-3590. [PMID: 38846838 PMCID: PMC11152847 DOI: 10.1097/ms9.0000000000002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/14/2024] [Indexed: 06/09/2024] Open
Abstract
Aortic valve stenosis is a disease characterized by thickening and narrowing of the aortic valve (AV), most commonly due to calcification, which leads to left ventricular outflow obstruction called calcific aortic valve disease (CAVD). CAVD presents as a progressive clinical syndrome with cardiorespiratory symptoms, often with rapid deterioration. The modern-day pathophysiology of CAVD involves a complex interplay of genetic factors, chronic inflammation, lipid deposition, and valve calcification, with early CAVD stages resembling atherosclerosis. Various imaging modalities have been used to evaluate CAVD, with a recent trend of using advanced imaging to measure numerous AV parameters, such as peak jet velocity. Significant improvements in mortality have been achieved with transcatheter AV repair, but numerous therapeutics and modalities are being researched to delay the progression of CAVD. This article aims to provide a comprehensive review of CAVD, explore recent developments, and provide insights into future treatments with various novel modalities.
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Affiliation(s)
- Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur
| | - Aman Goyal
- Department of Internal Medicine, Seth Gordhandas Sunderdas (GS) Medical College and King Edward Memorial (KEM) Hospital, Mumbai
| | | | - Noor U. Khan
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Jyoti Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur
| | - Shrey Chopra
- Department of Internal Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi
| | | | | | - Kush Patel
- Department of Internal Medicine, Baroda Medical College, Gujarat
| | - Kaarvi Khullar
- Department of Internal Medicine, Government Medical College and Hospital, Gondia, Maharashtra, India
| | - Mohamed Daoud
- Department of Internal Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Amir H. Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
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Taoussi R, Khattab H, Jadib A, Daki A, Bendahou H, Sabiri M, Manjra SE, Lezar S, Essodegui F. Transient ischemic attack due to multiple spontaneous calcified embolus of the cerebral arteries on a calcified mitral and aortic stenosis. Radiol Case Rep 2022; 17:2899-2901. [PMID: 35733951 PMCID: PMC9207546 DOI: 10.1016/j.radcr.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Reda Taoussi
- Central Imaging Department, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
| | - Hajar Khattab
- Department of Neurology, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
| | - Abdelhamid Jadib
- Central Imaging Department, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
- Corresponding author.
| | - Anouar Daki
- Central Imaging Department, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
| | - Hajar Bendahou
- Department of Cardiology, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
| | - Mouna Sabiri
- Central Imaging Department, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
| | - Samia El Manjra
- Central Imaging Department, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
| | - Samira Lezar
- Central Imaging Department, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
| | - Fatiha Essodegui
- Central Imaging Department, Ibn Rochd University Hospital, 1 quartier des hopitaux, Casablanca, Morocco
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Mosqueira AJ, Canneti B, Martínez Calvo A, Fernández Armendáriz P, Seijo-Martinez M, Pumar JM. Calcified cerebral embolism: a 9 case series and review of the literature. Neurologia 2022; 37:421-427. [PMID: 31331677 DOI: 10.1016/j.nrl.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/26/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Calcified cerebral embolism (CCE), a rarely reported and underdiagnosed cause of stroke, may be the first manifestation of a vascular or cardiac disease. Our purpose is to describe the characteristics of CCE in a series of 9 cases and review the literature on the subject. PATIENTS AND METHODS We included patients with CCE from 3 different hospitals. We described the diagnostic approach, neuroimaging findings, origin of the embolism, treatment, and prognosis of these patients. RESULTS We identified a total of 9 patients presenting spontaneous CCE as the cause of acute ischaemic stroke. In all cases, the middle cerebral artery was affected; all patients underwent CT. A possible calcific source was found in 6 patients (66.6%), originated in the carotid arteries in 3 (33.3%) and in the heart in the other 3 patients (33.3%). Only one patient was treated in the acute phase (trombectomy) and only 11% of patients had modified ranking scale scores ≤ 2 at 3 months. CONCLUSIONS CCE is more frequent than previously thought and, although the condition continues to be underdiagnosed, it is of considerable prognostic relevance in the aetiological study of stroke.
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Affiliation(s)
- A J Mosqueira
- Servicio de Radiodiagnóstico, Hospital Universitario Santiago de Compostela, Santiago de Compostela (La Coruña), España.
| | - B Canneti
- Servicio de Neurología, Complejo Hospitalario Universitario Pontevedra, Pontevedra, España
| | - A Martínez Calvo
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - P Fernández Armendáriz
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - M Seijo-Martinez
- Servicio de Neurología, Complejo Hospitalario Universitario Pontevedra, Pontevedra, España
| | - J M Pumar
- Servicio de Radiodiagnóstico, Hospital Universitario Santiago de Compostela, Santiago de Compostela (La Coruña), España
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Mosqueira AJ, Canneti B, Martínez Calvo A, Fernández Armendáriz P, Seijo-Martinez M, Pumar JM. Calcified cerebral embolism: a 9-case series and review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:421-427. [PMID: 34785159 DOI: 10.1016/j.nrleng.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 04/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Calcified cerebral embolus (CCE), a rarely reported and underdiagnosed cause of stroke, may be the first manifestation of a vascular or cardiac disease. We describe the characteristics of CCE in a series of 9 cases and review the literature on the subject. PATIENTS AND METHODS We included patients with CCE from 3 different hospitals. We describe the diagnostic approach, neuroimaging findings, origin of the embolism, treatment, and prognosis of these patients. RESULTS We identified a total of 9 patients presenting spontaneous CCE as the cause of acute ischaemic stroke. In all cases, the middle cerebral artery was affected; all patients underwent CT. A possible calcific source was found in 6 patients (66.6%), originating in the carotid arteries in 3 (33.3%) and in the heart in the other 3 patients (33.3%). Only one patient was treated in the acute phase (trombectomy) and only 11% of patients had modified Ranking Scale scores ≤ 2 at 3 months. CONCLUSIONS CCE is more frequent than previously thought and, although the condition continues to be underdiagnosed, it is of considerable prognostic relevance in the aetiological study of stroke.
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Affiliation(s)
- A J Mosqueira
- Servicio de Radiodiagnóstico, Hospital Universitario Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - B Canneti
- Servicio de Neurología, Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - A Martínez Calvo
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - P Fernández Armendáriz
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - M Seijo-Martinez
- Servicio de Neurología, Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - J M Pumar
- Servicio de Radiodiagnóstico, Hospital Universitario Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
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Walker BS, Shah LM, Osborn AG. Calcified cerebral emboli, a "do not miss" imaging diagnosis: 22 new cases and review of the literature. AJNR Am J Neuroradiol 2014; 35:1515-9. [PMID: 24651819 DOI: 10.3174/ajnr.a3892] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Calcified cerebral emboli are a rarely reported but devastating cause of stroke and may be the first manifestation of vascular or cardiac disease. Our aim was to evaluate the diagnosis, prevalence, imaging appearance, presumed embolic source, treatment, and outcome of patients with calcified cerebral emboli. MATERIALS AND METHODS Our radiology information system was searched for all CT scans by using keywords "calcified," "emboli," and their permutations. The radiology information system was also searched to identify all "stroke" CT reports to calculate the prevalence of calcified cerebral emboli. We also performed a MEDLINE search to identify all published case reports. RESULTS Twenty-two cases were identified from our database, and 48 were cases reported from the literature. The middle cerebral artery was the site of 83% of calcified emboli. Presumed sources were calcific aortic stenosis (36%), carotid atherosclerotic plaque (30%), and mitral annular calcification (11%). Spontaneous embolism occurred in 86%. Surgical treatment was performed in 34% of patients. Sixty-four percent of the patients with calcified aortic stenosis underwent aortic valve replacement. Among those with identifiable arterial disease, 53% underwent endarterectomy. Forty-one percent of patients experienced at least 1 recurrent stroke. The prevalence of calcified cerebral emboli identified on stroke CT scans at our institution was 2.7%. Seventy-three percent of cases were correctly identified. Twenty-seven percent were misdiagnosed on initial interpretation, while 9% were overlooked on preliminary interpretation. CONCLUSIONS Calcified cerebral emboli are more common than previously assumed, are frequently overlooked or misinterpreted, affect clinical course when diagnosed, and carry substantial risk for recurrent stroke.
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Affiliation(s)
- B S Walker
- From the Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah.
| | - L M Shah
- From the Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - A G Osborn
- From the Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
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Kahlert P, Knipp SC, Schlamann M, Thielmann M, Al-Rashid F, Weber M, Johansson U, Wendt D, Jakob HG, Forsting M, Sack S, Erbel R, Eggebrecht H. Silent and Apparent Cerebral Ischemia After Percutaneous Transfemoral Aortic Valve Implantation. Circulation 2010; 121:870-8. [PMID: 20177005 DOI: 10.1161/circulationaha.109.855866] [Citation(s) in RCA: 399] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The risk of stroke after transfemoral aortic valve implantation (TAVI) due to dislodgement and subsequent embolization of debris from aortic arch atheroma or from the calcified valve itself ranges between 2% and 10%. The rate of clinically silent cerebral ischemia is unknown but may be even higher.
Methods and Results—
Thirty-two patients who underwent TAVI with the use of a balloon-expandable (n=22) or self-expandable (n=10) stent valve prosthesis were included in this descriptive study and compared with a historical control group of 21 patients undergoing open surgical aortic valve replacement. Periprocedural apparent and silent cerebral ischemia was assessed by neurological testing and serial cerebral diffusion-weighted magnetic resonance imaging at baseline, at 3.4 (2.5 to 4.4) days after the procedure, and at 3 months. TAVI was successful in all patients. After the procedure, new foci of restricted diffusion on cerebral diffusion-weighted magnetic resonance imaging were found in 27 of 32 TAVI patients (84%) and were more frequent than after open surgery (10 of 21 patients [48%];
P
=0.011). These lesions were usually multiple (1 to 19 per patient) and dispersed in both hemispheres in a pattern suggesting cerebral embolization. Volumes of these lesions were significantly smaller after TAVI than after surgery (77 [59 to 94] versus 224 [111 to 338] mm
3
;
P
<0.001). There were neither measurable impairments of neurocognitive function nor apparent neurological events during the in-hospital period among TAVI patients, but there was 1 stroke (5%) in the surgical patient group. On 3-month follow-up diffusion-weighted magnetic resonance imaging, there were no new foci of restricted diffusion, and there was no residual signal change associated with the majority (80%) of the foci detected in the periprocedural period.
Conclusions—
Clinically silent new foci of restricted diffusion on cerebral magnetic resonance imaging were detected in almost all patients (84%) undergoing TAVI. Although typically multiple, these foci were not associated with apparent neurological events or measurable deterioration of neurocognitive function during 3-month follow-up. Further work needs to be directed to determine the clinical significance of these findings in a larger patient population.
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Affiliation(s)
- Philipp Kahlert
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stephan C. Knipp
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marc Schlamann
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Thielmann
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Fadi Al-Rashid
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marcel Weber
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Uwe Johansson
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Heinz G. Jakob
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefan Sack
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Holger Eggebrecht
- From the Departments of Cardiology (P.K., F.A.-R., M.W., S.S., R.E., H.E.) and Thoracic and Cardiovascular Surgery (S.C.K., M.T., D.W., H.G.J.), West German Heart Center Essen; and Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.) and Department of Neurology (U.J.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
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