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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
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Management of Ischemic Stroke Following Left Ventricular Assist Device
Leigh A Rettenmaier1, Aayushi Garg2, Kaustubh Limaye2
1Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.
Summary
Acute ischemic stroke in patients with left ventricular assist devices (LVAD) is common. Mechanical thrombectomy is a viable treatment, but continuing anticoagulation requires careful risk-benefit assessment due to hemorrhagic transformation risks.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Acute ischemic stroke is a significant complication in patients with left ventricular assist devices (LVADs).
- Management protocols for ischemic stroke in LVAD patients are lacking.
- This study evaluates the experience of treating acute ischemic stroke post-LVAD placement.
Purpose of the Study:
- To analyze the incidence and management of acute ischemic stroke in patients following LVAD implantation.
- To identify treatment outcomes and complications in this patient population.
Main Methods:
- Retrospective review of patients undergoing LVAD placement between 2010-2019.
- Identification and analysis of patients who experienced acute ischemic stroke post-LVAD.
Main Results:
- 8.8% of LVAD patients (19/216) experienced acute ischemic stroke.
- Most patients were on dual antiplatelet and anticoagulation therapy; subtherapeutic INRs were common.
- Mechanical thrombectomy was performed in 26.3% of cases; thrombolysis was contraindicated.
- Hemorrhagic transformation occurred in 31.6% of stroke patients.
Conclusions:
- Mechanical thrombectomy is a feasible treatment for acute ischemic stroke in LVAD patients when thrombolysis is contraindicated.
- Continuing anticoagulation during the acute stroke phase is common due to LVAD thrombosis concerns.
- Careful consideration of anticoagulation risks versus benefits is crucial, particularly regarding hemorrhagic transformation.
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