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Ischemic Stroke
Original research
Endovascular treatment for large vessel occlusion stroke in patients with ventricular assist devices
  1. Yoshinori Kadono1,
  2. Hajime Nakamura1,
  3. Shunsuke Saito2,
  4. Takeo Nishida1,
  5. Masatoshi Takagaki1,
  6. Tomoyoshi Shigematsu1,3,
  7. Katsunori Asai1,
  8. Tomoaki Murakami1,
  9. Kenichi Todo4,
  10. Toshiyuki Fujinaka1,
  11. Manabu Sakaguchi4,
  12. Koichi Toda2,
  13. Yoshiki Sawa2,
  14. Haruhiko Kishima1
  1. 1 Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
  2. 2 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
  3. 3 Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Hospital, New York, USA
  4. 4 Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
  1. Correspondence to Dr Hajime Nakamura, Neurosurgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; hajime{at}nsurg.med.osaka-u.ac.jp

Abstract

Background Embolic stroke with large vessel occlusion (LVO) is a major adverse event during ventricular assist device (VAD) support. In this study we aimed to clarify the efficacy of, and problems associated with, endovascular treatment (EVT) of LVO in patients with VAD support.

Methods We retrospectively reviewed EVT for LVO in patients with VAD support between 2006 and 2017 at our institute and evaluated baseline characteristics, treatment variables, outcomes, and complications.

Results The study cohort comprised 12 consecutive patients (age 35.4±20.4 years), with 15 LVO events involving 20 arterial occlusions, who had undergone EVT. The median Alberta Stroke Program Early CT score was 10 and good collaterals were observed in 10 of 17 occluded middle cerebral artery areas. No study patients had received intravenous thrombolysis therapy. EVT was performed on 18 of the 20 occluded arteries and mechanical thrombectomy on 13 vessels. The successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2 b) rate was 67% in all EVTs and 85% with mechanical thrombectomy. Histological analysis showed fibrin-rich thrombi in four of five samples. Seven of 12 patients (58%) maintained their neurological function (modified Rankin Scale score ≤2 or equal to pre-stroke score) at 90 days. Periprocedural complications comprised two symptomatic intracranial hemorrhages and the 90-day mortality rate was 13%. Seven of 10 cardiac transplant candidates (70%) returned to the waiting list and three of them received transplants.

Conclusions Endovascular therapy for acute LVO stroke is feasible even in patients with VAD support.

  • embolic
  • intervention
  • thrombectomy
  • stroke

https://doi.org/10.1136/neurintsurg-2018-014645

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    Footnotes

    • Contributors We certify that neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere. We now have any data upon which the manuscript is based and will provide such data upon request to the editors or readers. YK, HN and HK participated in the conception and design of the study. YK and MS collected the data. YK and HN conducted the statistical analysis and interpreted the results, and drafted the paper. SS, TN, MT and MS assisted with the interpretation of the results, and drafting the paper. TS, KA, TM, KeT, TF, KoT and HK critically revised the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data on which the manuscript is based will be provided upon request to the corresponding author.

    • Patient consent for publication Not required.