Show Summary Details
Page of

Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices 

Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
Chapter:
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
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2020. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 24 October 2020

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.