Abstract TP213: Ischemic And Hemorrhagic Stroke In Patients With Implantation Of Left Ventricular Assist Device
Background and Purpose: Stroke is one of the major complications in patients implanted with left ventricular assist device (LVAD). In Japan, the duration waiting for a heart transplant from a LVAD implantation is beyond 800 days. While antithrombotic therapy is often aggressively given, hemorrhagic stroke as well as ischemic one is a major complication that determines the outcome in these patients. However, the type of stroke in patients with LVAD implantation has not been fully investigated. The purpose of this study is to clarify the type and characteristic of acute stroke with LVAD implantation by using CT findings.
Methods: Between 2005 and 2011, we reviewed 110 consecutive cases underwent LVAD implantation. Among them, 49 cases (126 events in total) suffered from the acute stroke at least once. We analyzed the category, the sites of lesions and the CT findings of each acute stroke events.
Results: Among 49 acute stroke cases (5-74 yr old, 16 female and 33 male), brain infarction (n=39, 71 events), brain hemorrhage(n=25, 31 events) and subarachnoid hemorrhage (SAH) (n=23, 33 events) were identified. Thus, the incidence of hemorrhagic stroke is equal to that of ischemic stroke in patients with LVAD. In 71 infarct events, CT showed the lesion in the cortex (n=44), in the basal ganglia (n=17) and in the brain stem and cerebellum (n=17). Multiple infarctions were also observed in 29 events. In brain hemorrhage events (n=31), almost all were identified in the subcortical lesion (n=27), and none was seen in the basal ganglia. Hemorrhage in the infratentorial area (n=3) and intraventricular space (n=1) were rare. In SAH (n=33), we identified hemorrhage located only in one sulcus in 25 events. We tentatively called this small characteristic pattern of SAH “petite SAH”. Furthermore, in 12 events of “petite SAH”, fresh cortical infarction was simultaneously observed in CT.
Conclusions: CT findings of acute stroke after implantation of left ventricular assist device are characteristically multifocal cortical lesions, regardless of brain infarction and hemorrhage. Although the mechanisms underlying petite SAH are unknown, prevention and management of ischemic as well as hemorrhagic stroke is undoubtedly important to improve the outcome of patients with LVAD implantation.
- © 2012 by American Heart Association, Inc.