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Long-term outcomes following thrombectomy for acute ischemic stroke in patients with a left ventricular assist device: a case series and literature review

  • Original Article - Vascular Neurosurgery - Ischemia
  • Published:
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Abstract

Background

Left ventricular assist devices (LVADs) were developed for the treatment of patients with severe heart failure (HF) as a bridge to heart transplantation (HT). Although long-term LVAD support results in substantial improvements, their long-term use often leads to severe acute ischemic stroke (AIS). Serious neurological events make it difficult to continue LVAD support, and these patients are excluded as candidates for HT. AIS remains a challenging problem in patients receiving LVAD support. Recently, although thrombectomy has been established in selected patients who are independent, it has not been established in patients who are not completely independent, such as those with LVAD support.

Methods

We describe four AIS patients with severe HF who were implanted with an LVAD as a bridge to HT. Five mechanical thrombectomies were performed for AIS associated with an LVAD in four patients. A literature review is presented and compared to the present results.

Results

Good recanalization was achieved in all patients. In three cases, marked neurological improvement was observed, and modified Rankin Scale (mRS) scores were maintained without deterioration. The median total follow-up period was 592 days. In one patient, HT was successfully performed after thrombectomy. Currently, two of the patients without neurological deficits are awaiting HT.

Conclusions

Embolism is a major problem encountered by patients under LVAD support while waiting for an HT. Thrombectomy for AIS associated with LVAD support is a useful and safe treatment modality. It is possible to maintain a reasonable mRS score in patients who are not completely independent.

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Abbreviations

ADL:

Activities of daily living

AIS:

Acute ischemic stroke

CTA:

Computed tomography angiography

CTP:

Computed tomography perfusion

HF:

Heart failure

HT:

Heart transplantation

IV:

Intravenous

LDH:

Lactate dehydrogenase

LVO:

Large vessel occlusion

LVAD:

Left ventricular assist device

mRS:

Modified Rankin Scale

NIHSS:

National Institutes of Health Stroke scale

PT-INR:

Prothrombin time-international normalized ratio

rt-PA:

Recombinant tissue-plasminogen activator

TICI:

Thrombolysis in cerebral infarction

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Bikei Ryu, Tatsuya Ishikawa, Koji Yamaguchi, Go Matsuoka, Seiichiro Eguchi & Takakazu Kawamata

Authors
  1. Bikei Ryu
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  2. Tatsuya Ishikawa
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  3. Koji Yamaguchi
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  4. Go Matsuoka
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  5. Seiichiro Eguchi
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  6. Takakazu Kawamata
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Corresponding author

Correspondence to Bikei Ryu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Tokyo Women’s Medical University) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all participants included in the study. All patients or relatives provided written informed consent for the surgical procedures and for the use of their data in the study.

Additional information

This article is part of the Topical Collection on Vascular Neurosurgery - Ischemia

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Ryu, B., Ishikawa, T., Yamaguchi, K. et al. Long-term outcomes following thrombectomy for acute ischemic stroke in patients with a left ventricular assist device: a case series and literature review. Acta Neurochir 160, 1729–1735 (2018). https://doi.org/10.1007/s00701-018-3635-4

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  • DOI: https://doi.org/10.1007/s00701-018-3635-4

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