The management of acute ischemic strokes and the prevalence of large vessel occlusion in left ventricular assist device

Cory J. Rice, Sung-Min Cho, Lucy Q. Zhang, Catherine Hassett, Randall C. Starling, Ken Uchino

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)213-217
Number of pages5
JournalCerebrovascular Diseases
Volume46
Issue number5-6
DOIs
StatePublished - Feb 1 2019

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Heart-Assist Devices
Stroke
International Normalized Ratio
Middle Cerebral Artery Infarction
National Institutes of Health (U.S.)
Therapeutics
Critical Illness
Neuroimaging
Registries
Hospitalization

Keywords

  • Endovascular therapy
  • Ischemic stroke
  • Large vessel occlusion
  • Left ventricular assisted device

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

The management of acute ischemic strokes and the prevalence of large vessel occlusion in left ventricular assist device. / Rice, Cory J.; Cho, Sung-Min; Zhang, Lucy Q.; Hassett, Catherine; Starling, Randall C.; Uchino, Ken.

In: Cerebrovascular Diseases, Vol. 46, No. 5-6, 01.02.2019, p. 213-217.

Research output: Contribution to journalArticle

Rice, Cory J. ; Cho, Sung-Min ; Zhang, Lucy Q. ; Hassett, Catherine ; Starling, Randall C. ; Uchino, Ken. / The management of acute ischemic strokes and the prevalence of large vessel occlusion in left ventricular assist device. In: Cerebrovascular Diseases. 2019 ; Vol. 46, No. 5-6. pp. 213-217.
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AB - 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.

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