TransCranial Doppler for REDUCtion of Silent strokE During MitraClip Implantation
TransCranial Doppler for REDUCtion of Silent strokE During MitraClip Implantation
The primary goal of the TCD-REDUCE study is to demonstrate the effectiveness of continuous
 transcranial Doppler sonography ("sonolysis") on the reduction of the ischemic stroke volume
 during MitraClip implantation.
Cardiac procedures are associated with new cerebral ischemic lesions detected on
 diffusion-weighted MRI (Bendszus et al., 2006).

 A previous study suggests that sonolysis (continuous transcranial Doppler sonography using a
 2-MHz diagnostic probe) can reduce the risk of new cerebral ischemic lesions during carotid
 endarterectomy and carotid angioplasty / stenting (Skoloudik et al., 2015).

 Currently, it is unknown whether sonolysis can also reduce the risk of new cerebral ischemic
 lesions during MitraClip implantation - a percutaneous treatment option in patients with
 moderate / severe mitral regurgitation.

 In this study, patients will receive cerebral MRI and clinical neurological /
 neuropsychological examination before and after MitraClip implantation. During MitraClip
 implantation, all patients will receive continuous transcranial Doppler sonography using a
 2-MHz diagnostic probe with maximal diagnostic energy administered through either the left or
 the right transtemporal window (computer-generated 1:1 randomization).

 The primary endpoint is the median ischemic lesion volume detected on diffusion-weighted MRI
 after MitraClip implantation in the sonolysis group and in the control group.
Inclusion Criteria:

 Patients with mitral regurgitation that are assigned to the MitraClip implantation by an
 interdisciplinary heart team according to current guidelines.

 Exclusion Criteria:

 -  contraindication to MRI examination (e.g. pace-maker, implanted metal material,
 claustrophobia)

 -  pregnancy

 -  unable to consent

 -  no transtemporal window