Related Experiment Video
Updated: Dec 18, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device:
Walid Oulehri1,2, Mircea Cristinar3, Gharib Ajob3
1Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 1, Place de l'Hôpital, 67000, Strasbourg, France. walid.oulehri@chru-strasbourg.fr.
Background:
Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy.
Case Presentation:
A 39-year-old man presented with cardiogenic shock following an out-of-hospital cardiac arrest. After a period of stabilization, the patient was referred for LVAD placement. Upon recovery from anesthesia, he presented with acute neurological deficits suggestive of IS. A brain computed tomography confirmed the diagnosis, and an emergency decompressive hemicraniectomy (DHC) was performed. Anticoagulation was managed empirically. The patient's neurological status progressively improved and he was referred for heart transplantation at five months from DHC. One month later, cranioplasty was performed.
Conclusions:
This report suggests an anticoagulation management approach in combination with decompressive craniectomy after IS in a patient with LVAD placement was successful. An optimized anticoagulation management and collaborative team-based practice may contribute to successful outcomes in complex cases.
