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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device-Associated Stroke

Sung-Min Cho1, Pouya Tahsili-Fahadan1,2,3, Ahmet Kilic4

  • 1Division of Neurocritical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Seminars in Neurology
|April 14, 2021
PubMed

Insights

Left ventricular assist device (LVAD) use is rising, but stroke remains a major risk. This review covers LVAD-associated stroke mechanisms, diagnosis, and management strategies for advanced heart failure patients.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Left ventricular assist device (LVAD) implantation is increasing for advanced heart failure.
  • Stroke, including ischemic stroke and intracranial hemorrhage, is a primary cause of death and disability in LVAD patients.
  • Current understanding of LVAD-associated stroke mechanisms and optimal management remains limited and controversial.

Purpose of the Study:

  • To review the current knowledge on the pathophysiology and risk factors of stroke in patients with LVADs.
  • To outline the diagnostic approach for identifying stroke in this population.
  • To discuss evidence-based treatment strategies for LVAD-associated stroke.

Main Methods:

  • Literature review of recent studies on LVADs and stroke.
  • Analysis of pathophysiological mechanisms linking LVADs to cerebrovascular events.
  • Synthesis of diagnostic criteria and imaging modalities.
  • Evaluation of current and emerging therapeutic interventions.

Main Results:

  • LVADs are associated with significant risks of both ischemic stroke and intracranial hemorrhage.
  • Risk factors include device type, anticoagulation/antiplatelet strategies, and patient-specific comorbidities.
  • Diagnostic challenges exist due to overlapping symptoms with other LVAD complications.
  • Management strategies involve balancing anticoagulation needs with bleeding risks.

Conclusions:

  • Stroke remains a critical complication of LVAD therapy, impacting patient outcomes.
  • A comprehensive understanding of pathophysiology and risk factors is essential for prevention.
  • Standardized diagnostic and management protocols are needed to improve care for LVAD patients experiencing stroke.

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