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Updated: Aug 23, 2025
Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
Radiographic risk factors for intracranial hemorrhage in patients with left ventricular assist devices
Nicholas S Hernandez1, Matthew Kanter1, Vaishnavi Sharma1
1Tufts University School of Medicine, 145 Harrison Ave. Boston, M.A., 02111; Department of Neurosurgery, Tufts Medical Center, 300 Washington Ave., Boston, M.A., 02111.
Insights
Intracranial hemorrhage (ICH) risk in left ventricular assist device (LVAD) patients is linked to imaging findings. CT scans can identify patients with intracranial mass, vascular pathology, or microangiopathy at higher risk.
Area of Science:
- Neurosurgery
- Cardiology
- Radiology
Background:
- Intracranial hemorrhage (ICH) is a severe complication in patients with left ventricular assist devices (LVADs).
- While demographic risk factors are known, anatomical predispositions for ICH in LVAD patients remain unclear.
- This study investigates radiographic predictors of ICH in LVAD recipients.
Approach:
- A retrospective review of 440 LVAD patients (2008-2021) was conducted.
- Head CT scans obtained within 5 years of LVAD placement were analyzed for 288 patients (21 with ICH, 267 controls).
- Demographic, radiographic, and management data were meticulously collected and analyzed.
Key Points:
- The overall incidence of ICH was 8.6%.
- Radiographic findings of intracranial mass, vascular pathology, and microangiopathy were significantly associated with ICH.
- Multivariate analysis confirmed these as independent risk factors: mass (aOR 332.1), vascular pathology (aOR 69.7), and microangiopathy (aOR 6.5).
Conclusions:
- Intracranial mass, vascular pathology, and microangiopathy identified on CT imaging are independent risk factors for ICH in LVAD patients.
- These radiographic markers can help stratify ICH risk.
- CT imaging should be utilized to identify high-risk patients for ICH during LVAD therapy.
Objective:
Intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVAD) is a devastating complication. Demographic risk factors for ICH in LVAD patients are defined, however anatomic predispositions to ICH are unknown. We sought to interrogate intracranial radiographic risk factors for ICH in LVAD patients.
Methods:
We reviewed 440 patients who received an LVAD from 2008-2021. We selected patients with CT scans of the head either before or after LVAD placement, but typically within 5 years. 288 patients (21 ICH, 267 Control) with imaging were included. A detailed chart review was performed on demographics, radiographic features, and management.
Results:
The incidence of ICH in our total cohort was 8.6% (38/440). The presence of pump thrombosis (p=0.001), driveline infection (p=0.034), other hemorrhage (p=0.001), or previous placement of a cardio-defibrillator (p=.003) was associated with increased risk for ICH. An analysis of imaging revealed that the presence of a mass (p=0.006), vascular pathology (p=0.001), and microangiopathy (p=0.04) was significantly associated with ICH in LVAD patients. These radiographic features were validated with a multivariate logistic regression which confirmed presence of a mass (aOR 332.1, 95% CI: 14.7-7485.1, p<0.001), vascular pathology (aOR 69.7, 95% CI: 1.8-2658.8, p=0.022), and microangiopathy (aOR 6.5, 95% CI: 1.1-37.6, p=0.035) were independently associated with ICH.
Conclusion:
Radiographic evidence of microangiopathy, intracranial mass, and vascular pathology are independent risk factors for ICH which are readily identified by imaging. We advocate that CT imaging be used to further stratify patients at highest risk of ICH during treatment with an LVAD.
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