Abstract TP409: Prevalence and Predictors of Stroke in Patients With Short-Term Mechanical Circulatory Support Devices: A Single-Center Study

Abstract

Introduction: Short-term mechanical circulatory support devices (ST-MCS) include intra-aortic balloon-pump (IABP), extracorporeal membrane oxygenation (ECMO) and the CentriMag® and Impella® ventricular assist systems (VAS). Despite an exponential increase in their use, data regarding stroke prevalence and predictors are lacking. Objective: To identify the prevalence and predictors of stroke in ST-MCS. Methods: Data was collected prospectively into a database from January 2016 to June 2018 and retrospectively extracted and analyzed. Primary analysis was performed between acute-stroke vs. non-stroke diagnoses. Dichotomous and continuous variables were analyzed using Chi-Square test of proportions and Wilcoxon Ranked Sum test respectively. Results: Out of 203 ST-MCS-patients [IABP 31.5% (n=64), Impella 24.6% (n=50), ECMO 31% (n=63) and CentriMag®VAS 12.8% (n=26)], 8.4% (n=17) had an acute stroke. Among them 6.4% (n=13) had ischemic stroke and 1% (n=2) had hemorrhagic stroke, with 1% (n=2) having both. CentriMag®VAS had a higher stroke rate than the other devices (23.1% [n=6] vs. 6.2% [n=11]; p=0.011, OR 4.53). Predictors of stroke in all patients were central cannulation (p=0.044, OR 3.08), duration >4 days (p=0.025, OR 3.21) and use of another ST-MCS device before primary device (p=0.043, OR 1.45). Flow-rate (p=0.86) and catheter size (p=0.15) did not predict stroke. Only 1 patient was eligible for thrombolytic therapy and received IV tPA, with the most common reasons to hold treatment being unknown last-seen-normal (n=8), coagulopathy (n=2) and established infarct on head CT (n=2). A large vessel occlusion was present in 20% (n=3), but none underwent a mechanical thrombectomy due of established infarction. All hemorrhagic strokes and 47% (n=7) ischemic strokes led to withdrawal of care. Conclusion: About 1 in 12 patients placed on a ST-MCS device may have an acute stroke, but this can be as high as 1 in 5 with the use of the CentriMag®VAS. Factors such as central cannulation, duration >4 days and use of another ST-MCS device before the primary device may be predictive of acute stroke in these patients. Further research in the identification of such predictors, in conjunction with early symptom recognition could help improve treatment rates.