Mauro Bergui1, Davide Castagno1, Federico D'Agata2, Alessandro Cicerale1, Matteo Anselmino1, Federica Maria Ferrio1, Carla Giustetto1, Franck Halimi1, Marco Scaglione1, Fiorenzo Gaita1. 1. From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.). 2. From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.). federico.dagata@unito.it.
Abstract
BACKGROUND AND PURPOSE: Endovascular procedures, including atrial fibrillation transcatheter ablation, may cause microembolization of brain arteries. Microemboli often cause small sized and clinically silent cerebral ischemias (SCI). These lesions are clearly visible on early postoperative magnetic resonance diffusion-weighted images. We analyzed SCI distribution in a population of patients submitted to atrial fibrillation transcatheter ablation. METHODS: Seventy-eight of 927 consecutive patients submitted to atrial fibrillation transcatheter ablation were found positive for acute SCI on a postoperative magnetic resonance. SCI were identified and marked, and their coordinates were transformed from native space into the International Consortium for Brain Mapping/Montreal Neurological Institute space. We then computed the voxel-wise probability distribution map of the SCI using the activation likelihood estimation approach. RESULTS: SCI were more commonly found in the cortex. In supratentorial regions, SCI selectively involved cortical border zone between anterior, middle, and posterior cerebral arteries; in infratentorial regions, distal territory of posteroinferior cerebellar artery. Possible explanations include selective embolization, linked to the vascular anatomy of pial arteries supplying those territories, reduced clearance of emboli in a relatively hypoperfused zone, or a combination of both. This particular distribution of lesions has been reported in both animal models and in patients with microemboli of different sources. CONCLUSIONS: A selective vulnerability of cortical border zone to microemboli occurring during atrial fibrillation transcatheter ablation was observed. We hypothesize that such selectivity may apply to microemboli of different sources.
BACKGROUND AND PURPOSE: Endovascular procedures, including atrial fibrillation transcatheter ablation, may cause microembolization of brain arteries. Microemboli often cause small sized and clinically silent cerebral ischemias (SCI). These lesions are clearly visible on early postoperative magnetic resonance diffusion-weighted images. We analyzed SCI distribution in a population of patients submitted to atrial fibrillation transcatheter ablation. METHODS: Seventy-eight of 927 consecutive patients submitted to atrial fibrillation transcatheter ablation were found positive for acute SCI on a postoperative magnetic resonance. SCI were identified and marked, and their coordinates were transformed from native space into the International Consortium for Brain Mapping/Montreal Neurological Institute space. We then computed the voxel-wise probability distribution map of the SCI using the activation likelihood estimation approach. RESULTS: SCI were more commonly found in the cortex. In supratentorial regions, SCI selectively involved cortical border zone between anterior, middle, and posterior cerebral arteries; in infratentorial regions, distal territory of posteroinferior cerebellar artery. Possible explanations include selective embolization, linked to the vascular anatomy of pial arteries supplying those territories, reduced clearance of emboli in a relatively hypoperfused zone, or a combination of both. This particular distribution of lesions has been reported in both animal models and in patients with microemboli of different sources. CONCLUSIONS: A selective vulnerability of cortical border zone to microemboli occurring during atrial fibrillation transcatheter ablation was observed. We hypothesize that such selectivity may apply to microemboli of different sources.
Authors: Ava L Liberman; Ali Zandieh; Caitlin Loomis; Jonathan M Raser-Schramm; Christina A Wilson; Jose Torres; Koto Ishida; Swaroop Pawar; Rebecca Davis; Michael T Mullen; Steven R Messé; Scott E Kasner; Brett L Cucchiara Journal: Stroke Date: 2017-01-11 Impact factor: 7.914
Authors: Tarek Mohammed El-Gammal; Wafik Said Bahnasy; Osama Abd Allah Ragab; Ayman Mohammed Al-Malt Journal: Egypt J Neurol Psychiatr Neurosurg Date: 2018-04-25