Intraoperative Management of Carotid Endarterectomy in Patients With Left Ventricular Assist Devices-The Challenge of Continuous Flow: A Case Report

A A Pract. 2020 Dec;14(14):e01355. doi: 10.1213/XAA.0000000000001355.


Symptomatic carotid artery disease stenosis warrants open surgical carotid endarterectomy (CEA). However, patients with continuous-flow left ventricular assist devices (CF-LVADs) present unique challenges when vasopressors and volume are used to maintain cerebral perfusion pressure after carotid cross-clamping. This report describes patients with CF-LVADs who underwent CEA. We identify how preload, contractility, afterload, pump speed, mean arterial pressure, and anticoagulation should be addressed to maintain CF-LVAD outflow and cerebral perfusion during the procedure. Anesthesiologists can combine an understanding of continuous-flow physiology with invasive monitors to optimize cardiac output and cerebral blood flow during CEA procedures.

Publication types

  • Case Reports

MeSH terms

  • Carotid Stenosis* / surgery
  • Cerebrovascular Circulation
  • Endarterectomy, Carotid*
  • Heart-Assist Devices*
  • Humans
  • Vasoconstrictor Agents


  • Vasoconstrictor Agents