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Published on: August 12, 2014
Carotid Stenting in a Patient With Syncope and Left Ventricular Assist Device Placement
Omar A Sheikh1, Gordon X Wong1, Katherine M Gill1
1University Hospitals Harrington Heart & Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Insights
Carotid artery stenting may resolve syncope in patients with left ventricular assist devices (LVADs), despite limited data on this complex condition. This case demonstrates a safe and effective intervention for carotid artery stenosis in an LVAD patient.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Limited data exists on carotid artery stenting (CAS) in patients with durable ventricular assist devices (VADs).
- Clinical presentation, safety, and efficacy of CAS in this population are poorly understood.
- VADs significantly alter patient hemodynamics, complicating cardiovascular interventions.
Background:
There is a paucity of data regarding the clinical presentation and safety and efficacy of carotid artery stenting in patients with durable ventricular assist devices.
Case Summary:
A 60-year-old male with ischemic cardiomyopathy status post HeartMate-3 left ventricular assist device placement (LVAD) presented with recurrent syncopal episode despite extensive workup. Eventually, carotid duplex revealed left internal carotid artery stenosis (90% stenosis). After transfemoral carotid artery stenting, his syncopal symptoms completely resolved without any additional lightheadedness or dizziness.
Discussion:
In general, syncope is not considered a manifestation of carotid artery stenosis. However, in the setting of LVAD, this is possible. Furthermore, carotid artery intervention in patients with durable LVADs is rarely reported, and management strategies remain ill-defined. A comprehensive syncope evaluation and multidisciplinary discussion identified carotid artery disease as a potential significant contributor to his symptoms. The patient underwent transfemoral carotid artery stenting with complete resolution of syncope, dizziness, and lightheadedness.
Take-Home Messages:
Patients with concomitant clinically significant carotid artery stenosis and durable LVADs have complex hemodynamics that require a nuanced approach toward carotid artery revascularization. We demonstrate how carotid artery stenting can be performed safely in the setting of LVAD.
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