TY - JOUR
T1 - Mechanical thrombectomy in acute ischemic stroke patients with left ventricular assist device
AU - Kitano, Takaya
AU - Sakaguchi, Manabu
AU - Yamagami, Hiroshi
AU - Ishikawa, Tatsuya
AU - Ishibashi-Ueda, Hatsue
AU - Tanaka, Kanta
AU - Okazaki, Shuhei
AU - Sasaki, Tsutomu
AU - Kadono, Yoshinori
AU - Takagaki, Masatoshi
AU - Nishida, Takeo
AU - Nakamura, Hajime
AU - Yanase, Masanobu
AU - Fukushima, Norihide
AU - Shiozawa, Masayuki
AU - Toyoda, Kazunori
AU - Takahashi, Jun C.
AU - Funatsu, Takayuki
AU - Ryu, Bikei
AU - Yoshioka, Daisuke
AU - Toda, Koichi
AU - Murayama, Shigeo
AU - Kawamata, Takakazu
AU - Kishima, Haruhiko
AU - Sawa, Yoshiki
AU - Mochizuki, Hideki
AU - Todo, Kenichi
N1 - Publisher Copyright:
© 2020 The Author(s)
PY - 2020/11/15
Y1 - 2020/11/15
N2 - Objectives: As the number of patients with left ventricular assist device (LVAD) implantation has been increasing, treatment of LVAD-related ischemic stroke is becoming a critical issue. We sought to clarify the features of mechanical thrombectomy in LVAD-related stroke with large vessel occlusion. Methods: In a multi-center, retrospective case-control study, we compared 20 LVAD-related strokes with 33 non-LVAD strokes, all of which had large vessel occlusion in the anterior circulation treated with mechanical thrombectomy. A comparative histopathological examination of the retrieved thrombi was also performed. Results: Successful reperfusion was achieved in 75% of the LVAD-related strokes. The time from onset to reperfusion was similar to that of non-LVAD strokes, but the total number of device passes required for reperfusion (median, 2.5 versus 1, P = 0.01) and the incidences of post-procedural parenchymal and subarachnoid hemorrhage (25% versus 3%, P = 0.02 and 55% versus 15%, P = 0.01, respectively) were higher in LVAD-related strokes. Symptomatic intracranial hemorrhage occurred in 4 patients (20%) with LVAD-related strokes. The histopathological analysis revealed that the ratio of erythrocyte components was significantly lower in thrombi retrieved from patients with LVAD-related stroke than in those with non-LVAD stroke (19 ± 6% versus 41 ± 17%, P = 0.01). Conclusions: Mechanical thrombectomy is feasible in patients with LVAD-related stroke. However, repetitive device passes are needed to achieve successful reperfusion mainly because of the structurally organized thrombi, and the higher risk of hemorrhagic complications should be considered, while offering this therapeutic alternative.
AB - Objectives: As the number of patients with left ventricular assist device (LVAD) implantation has been increasing, treatment of LVAD-related ischemic stroke is becoming a critical issue. We sought to clarify the features of mechanical thrombectomy in LVAD-related stroke with large vessel occlusion. Methods: In a multi-center, retrospective case-control study, we compared 20 LVAD-related strokes with 33 non-LVAD strokes, all of which had large vessel occlusion in the anterior circulation treated with mechanical thrombectomy. A comparative histopathological examination of the retrieved thrombi was also performed. Results: Successful reperfusion was achieved in 75% of the LVAD-related strokes. The time from onset to reperfusion was similar to that of non-LVAD strokes, but the total number of device passes required for reperfusion (median, 2.5 versus 1, P = 0.01) and the incidences of post-procedural parenchymal and subarachnoid hemorrhage (25% versus 3%, P = 0.02 and 55% versus 15%, P = 0.01, respectively) were higher in LVAD-related strokes. Symptomatic intracranial hemorrhage occurred in 4 patients (20%) with LVAD-related strokes. The histopathological analysis revealed that the ratio of erythrocyte components was significantly lower in thrombi retrieved from patients with LVAD-related stroke than in those with non-LVAD stroke (19 ± 6% versus 41 ± 17%, P = 0.01). Conclusions: Mechanical thrombectomy is feasible in patients with LVAD-related stroke. However, repetitive device passes are needed to achieve successful reperfusion mainly because of the structurally organized thrombi, and the higher risk of hemorrhagic complications should be considered, while offering this therapeutic alternative.
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U2 - 10.1016/j.jns.2020.117142
DO - 10.1016/j.jns.2020.117142
M3 - Article
C2 - 32977225
AN - SCOPUS:85091231490
SN - 0022-510X
VL - 418
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 117142
ER -