- 1 A Historical Perspective on the Development of Mechanical Circulatory Support Devices
- 2 Indications for Mechanical Circulatory Support
- 3 Frailty: Assessment and Associations with Outcomes
- 4 Palliative Care in Mechanical Circulatory Support
- 5 Psychosocial Assessment of Patients Considered for Mechanical Circulatory Support
- 6 Left Ventricular Assist Device Backup for Conventional Surgery
- 7 Preoperative Strategies for Optimizing Mechanical Circulatory Support
- 8 Mechanical Circulatory Support in Patients with Pulmonary Hypertension
- 9 Selecting Children for Mechanical Circulatory Support
- 10 Device Selection for Short- and Long-Term Mechanical Circulatory Support
- 11 The HeartMate II™ Continuous-Flow Left Ventricular Assist System
- 12 The Abbott HeartMate 3™ Left Ventricular Assist System
- 13 The HeartWare<sup>™</sup> HVAD<sup>™</sup> Left Ventricular Assist Device
- 14 The Medtronic Miniature Left Ventricular Assist Device (MVAD)<sup>™</sup> System
- 15 The ReliantHeart aVAD<sup>©</sup>
- 16 The Syncardia Total Artificial Heart
- 17 Counterpulsation Circulatory Assist Devices
- 18 Abiomed Impella Platform
- 19 The Tandem: Life System
- 20 The Abbott CentriMag™ Acute Circulatory Support System and the HeartMate Percutaneous Heart Pump™
- 21 Extracorporeal Membrane Oxygenation
- 22 The Berlin Heart Ventricular Assist Devices
- 23 EVAHEART<sup>®</sup> 2 Left Ventricular Assist Device System
- 24 Anesthesia
- 25 Perfusion Considerations
- 26 Echocardiography in Left Ventricular Assist Device Recipients
- 27 Implantation of Continuous-Flow Left Ventricular Assist Devices via Sternotomy Technical Considerations
- 28 The Less-Invasive (Lateral) Approach to Left Ventricular Device Implantation
- 29 Concomitant Cardiac Valve Procedures with Circulatory Support Device Implantation
- 30 Providing Mechanical Support to Children Size and Anatomical Considerations
- 31 Postoperative Management after Assist Device Implantation
- 32 Anticoagulation Strategies for Patients on Mechanical Circulation Support
- 33 Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- 34 Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
- 35 Pump Thrombosis
- 36 Infectious Complications of Mechanical Circulatory Support
- 37 Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- 38 Right Heart Dysfunction
- 39 Renal Failure and Mechanical Circulatory Support Devices
- 40 Arrhythmia/Ventricular Tachycardia Ablation
- 41 Aortic Regurgitation in Patients with Left Ventricular Assist Devices
- 42 Modalities of Left Ventricular Assist Device Optimization
- 43 The CardioMEMS Heart Failure Monitoring System
- 44 Mechanical Circulatory Support as a Bridge to Recovery
- 45 Cardiac and Physical Rehabilitation
- 46 The VAD Coordinator Roles and Responsibilities in Caring for Patients with Ventricular Assist Devices
(p. 299) Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- Chapter:
- (p. 299) Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- Author(s):
Michael Eugene Kiyatkin
and Joshua Zebadiah Willey
- DOI:
- 10.1093/med/9780190909291.003.0037
The left ventricular assist device (LVAD) is increasingly used to treat end-stage heart failure and cardiogenic shock. Stroke is a leading complication of LVAD implantation, with an annual incidence of up to 20%, even with the latest models. The pathogenesis of ischemic and hemorrhagic stroke during LVAD support is multifactorial, with possible contributions including pump thrombosis, coagulopathy, and endothelial dysfunction secondary to pathological continuous flow. Strategies to prevent or minimize the risk of stroke have included preventing hypertension, using fewer thrombogenic materials in pump designs, optimizing anticoagulation, and implementing artificial pulsatility. In patients with LVADs, stroke is diagnosed from history, physical examination, and imaging (most importantly, computed tomography). Targeted endovascular therapy is preferred for treating ischemic stroke, and cautious reversal of anticoagulation is indicated for treating hemorrhagic stroke. The incidence of ischemic and hemorrhagic stroke after LVAD implantation continues to be unacceptably high. Further research in the pathophysiology, diagnosis, and treatment of stroke in patients with LVADs is needed, especially as these devices become more prevalent.
Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.
Please subscribe or login to access full text content.
If you have purchased a print title that contains an access token, please see the token for information about how to register your code.
For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.
- 1 A Historical Perspective on the Development of Mechanical Circulatory Support Devices
- 2 Indications for Mechanical Circulatory Support
- 3 Frailty: Assessment and Associations with Outcomes
- 4 Palliative Care in Mechanical Circulatory Support
- 5 Psychosocial Assessment of Patients Considered for Mechanical Circulatory Support
- 6 Left Ventricular Assist Device Backup for Conventional Surgery
- 7 Preoperative Strategies for Optimizing Mechanical Circulatory Support
- 8 Mechanical Circulatory Support in Patients with Pulmonary Hypertension
- 9 Selecting Children for Mechanical Circulatory Support
- 10 Device Selection for Short- and Long-Term Mechanical Circulatory Support
- 11 The HeartMate II™ Continuous-Flow Left Ventricular Assist System
- 12 The Abbott HeartMate 3™ Left Ventricular Assist System
- 13 The HeartWare<sup>™</sup> HVAD<sup>™</sup> Left Ventricular Assist Device
- 14 The Medtronic Miniature Left Ventricular Assist Device (MVAD)<sup>™</sup> System
- 15 The ReliantHeart aVAD<sup>©</sup>
- 16 The Syncardia Total Artificial Heart
- 17 Counterpulsation Circulatory Assist Devices
- 18 Abiomed Impella Platform
- 19 The Tandem: Life System
- 20 The Abbott CentriMag™ Acute Circulatory Support System and the HeartMate Percutaneous Heart Pump™
- 21 Extracorporeal Membrane Oxygenation
- 22 The Berlin Heart Ventricular Assist Devices
- 23 EVAHEART<sup>®</sup> 2 Left Ventricular Assist Device System
- 24 Anesthesia
- 25 Perfusion Considerations
- 26 Echocardiography in Left Ventricular Assist Device Recipients
- 27 Implantation of Continuous-Flow Left Ventricular Assist Devices via Sternotomy Technical Considerations
- 28 The Less-Invasive (Lateral) Approach to Left Ventricular Device Implantation
- 29 Concomitant Cardiac Valve Procedures with Circulatory Support Device Implantation
- 30 Providing Mechanical Support to Children Size and Anatomical Considerations
- 31 Postoperative Management after Assist Device Implantation
- 32 Anticoagulation Strategies for Patients on Mechanical Circulation Support
- 33 Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- 34 Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
- 35 Pump Thrombosis
- 36 Infectious Complications of Mechanical Circulatory Support
- 37 Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- 38 Right Heart Dysfunction
- 39 Renal Failure and Mechanical Circulatory Support Devices
- 40 Arrhythmia/Ventricular Tachycardia Ablation
- 41 Aortic Regurgitation in Patients with Left Ventricular Assist Devices
- 42 Modalities of Left Ventricular Assist Device Optimization
- 43 The CardioMEMS Heart Failure Monitoring System
- 44 Mechanical Circulatory Support as a Bridge to Recovery
- 45 Cardiac and Physical Rehabilitation
- 46 The VAD Coordinator Roles and Responsibilities in Caring for Patients with Ventricular Assist Devices