The Management of Acute Ischemic Strokes and the Prevalence of Large Vessel Occlusion in Left Ventricular Assist Device

Cerebrovasc Dis. 2018;46(5-6):213-217. doi: 10.1159/000495080. Epub 2018 Dec 4.

Abstract

Background: Ischemic and hemorrhagic strokes are frequent complications among those with left ventricular assist device (LVAD). Scarce data exist regarding the prevalence of acute large vessel occlusion (LVO) and treatment of acute ischemic stroke (AIS) in this setting.

Methods: We reviewed prospectively collected data of LVAD patient registry from a single, tertiary center from October 2004 to November 2016. Among those with AIS complications, patients were divided into early stroke (during implantation hospitalization) and late stroke (post-discharge) groups, and neuroimaging was reviewed and data on acute stroke therapy were collected.

Results: Of 477 persons with LVAD, 49 (10.3%) AIS occurred. The majority (29/49, 59%) of AIS occurred in-hospital. Thirty-two (65%) persons had international normalized ratios less than 1.7 at the time of AIS, but none qualified to receive acute intravenous thrombolysis. Of 25 (51%) persons who underwent CT angiography (CTA), 33% (16/49) had acute LVOs. Thirty-one percent (5/16) of persons with acute LVOs underwent intra-arterial endovascular therapy. All of 5 cases presented with middle cerebral artery syndrome with a median pre-procedural National Institutes of Health Stroke Scale of 13 (interquartile range 10-18). Successful recanalization was achieved in all 5 cases.

Conclusions: In-hospital strokes and acute LVOs are common in LVAD-associated AIS. Prompt evaluation with CTA and endovascular therapy should be pursued for these critically ill patients.

Keywords: Endovascular therapy; Ischemic stroke; Large vessel occlusion; Left ventricular assisted device.

MeSH terms

  • Aged
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / epidemiology
  • Brain Ischemia / therapy*
  • Cerebral Angiography / methods
  • Cerebral Arterial Diseases / diagnostic imaging
  • Cerebral Arterial Diseases / epidemiology
  • Cerebral Arterial Diseases / therapy*
  • Clinical Decision-Making
  • Computed Tomography Angiography
  • Endovascular Procedures* / adverse effects
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / epidemiology
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart-Assist Devices / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Ohio / epidemiology
  • Patient Selection
  • Prevalence
  • Prosthesis Design
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Stroke / diagnostic imaging
  • Stroke / epidemiology
  • Stroke / therapy*
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left*