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Iatrogenic cerebral infarction due tosurgery or endovascular therapy is usually only seen on magnetic resonance diffusion-weighted imaging (DWI) sequences .
These cerebral infarctions are usually "silent" and have no obvious symptoms .
Although patients do not undergo regular post-operative brain MRI, asymptomatic iatrogenic infarcts are common .
The risk is higher after neurointerventional procedures such as cerebral aneurysm coils, occurring in 49-67% of patients compared with 7-10% of patients undergoing other noncardiac procedures .
However, the clinical significance of iatrogenic infarction is uncertain .
There is growing evidence that iatrogenic cerebral infarction may lead to lasting brain damage
.
Histologically, they represent neuronal necrosis similar to symptomatic stroke
stroke
A 2016 meta-analysis of 8 studies (281 patients) concluded that treatment of unruptured cerebral aneurysms did not affect general cognitive function, but these studies were not concordant for iatrogenic infarcts by brain MR assessment
.
The most convincing evidence to date about the clinical sequelae of iatrogenic infarction comes from the NeuroVision prospective cohort study, which found that compared with older patients (≥65 years of age) without perioperative occult stroke, one year later Elderly patients with perioperative stationary stroke (n=78/1,114) were at higher risk for perioperative confusion and cognitive decline, as assessed using the Montreal Cognitive Assessment and Numerical Symbol Substitution Test
In the absence of convincing evidence of clinical consequences, iatrogenic cerebral infarction may be misinterpreted as an unimportant problem
.
Consider the increasing number of neurointerventional procedures (more than 300,000 angiograms per year in the US)
In this post hoc analysis, a multivariate model was used to assess the presence and number of iatrogenic infarcts on DWI with neurological impairment (National Institutes of Health Stroke Score [NIHSS]) , functional Correlations of status (modified Rankin score [MRS]) , cognition, and neuropsychiatric outcomes (30-minute test combination)
.
Quantile regression was also used to relate the number of infarcts to a Z -score-derived composite outcome score
In this post hoc analysis, a multivariate model was used to assess the presence and number of iatrogenic infarcts on DWI with neurological impairment (National Institutes of Health Stroke Score [NIHSS]) , functional Correlations of status (modified Rankin score [MRS]) , cognition, and neuropsychiatric outcomes (30-minute test combination)
- Among 184 patients (median age 56 years, IQR 50-64 years), 124 (67.
4%) had postoperative DWI lesions, and the median number of lesions was 4 (IQR2-10.
In this middle-aged cohort, iatrogenic cerebral infarction was associated with subtle differences in postoperative (1-4 days), 30-day outcomes assessed by different scales, and early dysfunction was associated with later differences
Ganesh A, Goyal M, Wilson AT, et al.
Association of Iatrogenic Infarcts With Clinical and Cognitive Outcomes in the Evaluating Neuroprotection in Aneurysm Coiling Therapy Trial [published online ahead of print, 2022 Feb 15].
Neurology.
2022;10.
1212/WNL.
0000000000200111.
doi:10.
1212/WNL.
0000000000200111 Leave a message here
