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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
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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.

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