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REVIEW ARTICLE

Silent cerebral injury after cardiac interventions: The role of advanced cardiac imaging at the neurocardiology interface

Mehmet Mustafa Yılmaz1 ,  Macit Kalçık2* ,  Osman Karaarslan1 ,  Oğuzhan Çelik3 ,  Abdullah Sarıhan4 ,  Mehmet Murat Şahin1 ,  Mucahit Yetim2 ,  Muhammet Cihat Çelik1 ,  Lütfü Bekar2 ,  Yusuf Karavelioğlu2
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1 Department of Cardiology, Hitit University Erol Olçok Education and Research Hospital, Çorum, Turkey
2 Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
3 Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
4 Department of Cardiology, Gediz State Hospital, Kütahya, Turkey
Brain & Heart, 026090011 https://doi.org/10.36922/BH026090011
Received: 28 February 2026 | Revised: 28 April 2026 | Accepted: 27 May 2026 | Published online: 14 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Silent cerebral injury (SCI) has emerged as a frequent but underrecognized consequence of contemporary cardiac interventions. Advances in diffusion-weighted magnetic resonance imaging have revealed that subclinical ischemic brain lesions occur commonly after procedures such as transcatheter valve implantation, surgical valve replacement, and percutaneous coronary intervention. Although these lesions do not produce immediate neurological symptoms, growing evidence suggests that they are associated with long-term adverse outcomes, including cognitive decline and increased risk of future stroke. The mechanisms underlying SCI are multifactorial and involve both embolic phenomena and transient cerebral hypoperfusion during procedural manipulation of cardiac and aortic structures. Traditional clinical risk models are limited in their ability to predict subclinical neurovascular injury. In this context, advanced cardiac imaging modalities, including transesophageal echocardiography, cardiac computed tomography, and, in selected cases, cardiac magnetic resonance imaging, may offer valuable insights by identifying structural features such as complex aortic plaques, prosthetic abnormalities, or extensive calcification that predispose to embolization. Integrating imaging-derived markers into pre-procedural assessment may support improved risk stratification and individualized procedural planning. This narrative review summarizes current evidence on SCI following cardiac interventions and explores the potential role of advanced cardiac imaging in predicting neurovascular complications. A greater integration of cardiovascular imaging and neurovascular outcomes may contribute to more effective strategies aimed at reducing subclinical brain injury in modern cardiac practice.

Keywords
Silent cerebral injury
Cardiac interventions
Transesophageal echocardiography
Cardiac computed tomography
Neurocardiology
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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