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Sulcus subarachnoid hemorrhage is a common stroke subtype in patients with implanted left ventricular assist devices
M Sakaguchi1,2, K Kitagawa3, S Okazaki1,2
1Stroke Center, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Insights
Acute stroke is a common complication after left ventricular assist device (LVAD) implantation. Brain CT scans reveal multifocal cortical lesions and a notable incidence of sulcus subarachnoid hemorrhage (SAH) in these patients.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Stroke is a significant complication in patients with left ventricular assist devices (LVADs).
- Understanding the characteristics of acute stroke in this population is crucial for patient management.
Purpose of the Study:
- To clarify the types and characteristics of acute stroke in patients following LVAD implantation.
- To analyze brain computed tomography (CT) findings associated with these strokes.
Main Methods:
- Reviewed 110 consecutive patients who underwent LVAD implantation between 2005 and 2012.
- Analyzed clinical categories, lesion sites, laboratory data, and CT findings of 115 acute stroke events in 49 patients.
- The pulsatile extracorporeal LVAD was the most commonly used device.
Main Results:
- Identified cerebral infarction (72 events), cerebral hemorrhage (31 events), and subarachnoid hemorrhage (SAH) (33 events).
- Mean of 2.3 stroke events per person; multiple infarctions occurred in 29% of infarction events.
- SAH localized within a single sulcus (sulcus SAH) was observed in 25 events.
Conclusions:
- CT findings of acute stroke post-LVAD implantation characteristically show multifocal cortical lesions.
- Sulcus SAH is a common and unexpected stroke subtype in LVAD patients.
- Careful examination for sulcus SAH is recommended in LVAD patients with non-specific neurological complaints.
Background And Purpose:
Stroke is one of the major complications observed in patients with an implanted left ventricular assist device (LVAD). The purpose of this study was to clarify the types and characteristics of acute stroke in patients after LVAD implantation by using brain computed tomography (CT) findings.
Methods:
Between 2005 and 2012, 110 consecutive patients who underwent LVAD implantation were reviewed. The most commonly used device was the pulsatile extracorporeal LVAD. Amongst them, 49 patients suffered from acute stroke at least once with a total of 115 stroke events. The clinical categories, lesion sites, laboratory data and CT findings of each acute stroke event were analyzed.
Results:
Cerebral infarction (35 patients, 72 events), cerebral hemorrhage (25 patients, 31 events) and subarachnoid hemorrhage (SAH) (23 patients, 33 events) were identified. A mean of 2.3 stroke events occurred per person. Of the 72 infarction events, multiple infarctions were observed in 29 events. Of the cerebral hemorrhage events (n = 31), almost all were subcortical lesions (n = 27) and none were observed in the basal ganglia. Of the 23 patients with SAH events (n = 33), SAH localized within a single sulcus, sulcus SAH, was observed in 25 events.
Conclusions:
Computed tomography findings of acute stroke after implantation of an LVAD are characteristically multifocal cortical lesions, regardless of brain infarction and hemorrhage. Unexpectedly, sulcus SAH was a common stroke subtype in patients with implanted LVADs. Sulcus SAH should be carefully examined in patients after LVAD implantation, when they complain of non-specific neurological complaints.
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