Cerebral Microembolization in Left Ventricular Assist Device Associated Ischemic Events

Catherine E. Hassett, Sung Min Cho, Cory J. Rice, Ibrahim Migdady, Randall C. Starling, Ken Uchino, Irene L. Katzan

Research output: Contribution to journalArticle

Abstract

Introduction: The significance of microembolic signals (MES) detected by transcranial Doppler ultrasound emboli monitoring (TCD-e) in patients supported with left ventricular assist devices (LVAD) remains unclear. We aimed to investigate the relationship between cerebral microembolization detected by TCD-e and acute ischemic events in LVAD patients. Methods: We reviewed consecutive patients with acute ischemic stroke or transient ischemic attack (TIA) in a prospectively collected database of LVAD patients. TCD-e exams consisted of monitoring the middle cerebral arteries for microembolic signals (MES) over 30 minutes. Results: Of 515 persons with LVAD, 41 TCD-e studies were performed in 35 patients with acute ischemic stroke or transient ischemic attack (TIA) in a median of 1 day (Interquartile range [IQR]: 0-2) after the event. MES were present in 15 (44%) TCD-e studies with a median MES count of 4 (IQR: 2-15.5). Bloodstream infections were more common in patients with MES (38% versus 8%, P =. 039). There were trends for lower international normalized ratio (1.39 versus 1.69, P =. 214), lower activated partial thromboplastin (33.2 versus 36.6, P =. 577), higher lactate dehydrogenase (531 versus 409, P =. 323) and a higher frequency of pump thrombosis (13% versus 8%, P =. 637) in patients with MES compared with those without MES. Conclusions: LVAD patients with acute ischemic stroke or TIA have a high prevalence of MES on TCD-e, which may serve as a marker for a prothrombotic state. Further study of MES in LVAD patients is warranted.

Original languageEnglish (US)
Article number104660
JournalJournal of Stroke and Cerebrovascular Diseases
DOIs
StateAccepted/In press - Jan 1 2020

    Fingerprint

Keywords

  • ischemic stroke
  • microembolic signals
  • thromboembolic event
  • transcranial Doppler
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this