The relation between left ventricular assist device (LVAD) inflow cannula malposition and pump thrombus has been reported. This study aimed to investigate pump position, derived from chest X-rays of HM3 patients, in correlation to any neurological dysfunction (ND) and specifically to ischemic stroke (IS) and intracranial hemorrhage (ICH). This retrospective analysis was performed on routinely acquired X-rays of 33 patients (Age: 62.4±9.3 yrs, male: 89.5%, BMI: 28.3±4.9kg/m2) implanted with a HM3 between 2014 and 2017. Device position was quantified in patients with and without any neurological dysfunction (noND) from frontal and lateral X-ray parameters characterizing the inflow cannula (IC), pump depth in relation to spine, diaphragm or horizontal line. The analysis of X-rays (38.6±24.3 days postoperative) revealed a significant smaller IC angle of HM3 patients with any ND vs. noND (2.52±11.59° vs. 13.92±9.74°, p=0.029). Additionally, the IC angle in the frontal view (IS: 0.23±11.34° vs. noIS: 13.92±9.45°, p=0.012) as well as the pump depth (IS: 19.7±16.8mm vs. noIS: 38.3±19.6mm, p=0.044) were significantly smaller for HM3 patients with IS. Using receiver operating characteristic (ROC) curve-derived cut-points, IC angle <10.06° provided 100% sensitivity and 72% specificity (C-statistic=0.867) for predicting IS. Stratified by IC angle, freedom from any IS at 12 months was 100% (>10.06°) and 50.4% (<10.06°) respectively (p=0.004). Further, no significant differences were found in any parameter between patients with and without ICH. In HM3 patients, inflow cannula malposition identified from X-rays serves as a risk factor for neurological dysfunction and especially ischemic stroke.