Ischemic Stroke and Intracranial Hemorrhages during Percutaneous Left Ventricular Assist Device Cardiac Support

Abstract

Mechanical circulatory support systems for cardiogenic shock and heart failure are associated with ischemic strokes and intracranial hemorrhages. Impella is a percutaneously placed, ventricular assist device for short-term cardiac support. We aimed to study the prevalence of acute neurologic complications during short-term support with Impella. We reviewed prospectively collected data of 79 consecutive persons implanted with Impella at a single, tertiary center between October 2010 to July 2018. Acute neurological events (ANE) were defined as ischemic strokes or intracranial hemorrhages, including intracerebral hemorrhage, subdural hematomas and subarachnoid hemorrhages. Among those with ANE, specific causes of ischemic and hemorrhagic events were collected and discussed. Of 79 persons with Impella with median 8 days of support (range 1-33 days), 6 (7.5%) developed ANE at a median of 5 days from implant (range 1-8 days). There were 3 ischemic strokes, 2 intracerebral hemorrhages, and 1subdural hematoma. Hemorrhagic events were attributed to anticoagulant use and thrombocytopenia at the time of the events. Two ischemic strokes were attributed to inadequate anticoagulation with one case of pump thrombosis diagnosed at time of ischemic stroke. Only 2 of the 6 patients survived the acute cardiogenic shock period to achieve heart transplantation. In-hospital ischemic strokes and intracranial hemorrhages are common during the short-term cardiac support period with Impella. Antithrombotic intensity, duration of device support time, and thrombocytopenia might contribute to the incidence of these events.