Mechanical thrombectomy in acute ischemic stroke patients with left ventricular assist device
Mechanical thrombectomy in acute ischemic stroke patients with left ventricular assist device
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DOI：
10.1016/j.jns.2020.117142
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发表时间：
2020-11-15
影响因子：
4.4
通讯作者：
Todo, Kenichi
中科院分区：
文献类型：
--
作者：
Kitano, Takaya;Sakaguchi, Manabu;Todo, Kenichi
目的：随着左室辅助装置（left ventricular assist device， LVAD）植入术患者数量的不断增加，LVAD相关性缺血性脑卒中的治疗成为一个关键问题。我们试图阐明机械取栓术治疗伴有大血管闭塞的lvad相关卒中的特点。方法：在一项多中心、回顾性病例对照研究中，我们比较了20例lvad相关卒中和33例非lvad卒中，这些卒中均有机械取栓治疗的前循环大血管闭塞。还对取出的血栓进行了比较组织病理学检查。结果：75%的lvad相关卒中患者再灌注成功。从发病到再灌注的时间与非lvad卒中相似，但在lvad相关卒中中，再灌注所需的器械总次数（中位数，2.5比1，P = 0.01）以及术后实质和蛛网膜下腔出血的发生率（分别为25%比3%，P = 0.02和55%比15%，P = 0.01）更高。4例（20%）lvad相关脑卒中患者出现症状性颅内出血。组织病理学分析显示，lvad相关卒中患者的血栓中红细胞成分的比例明显低于非lvad卒中患者（19 +/- 6% vs 41 +/- 17%, P = 0.01）。结论：机械取栓对lvad相关性脑卒中患者是可行的。然而，为了实现成功的再灌注，需要重复的装置通道，这主要是因为血栓的结构性组织，在提供这种治疗选择的同时，应考虑到出血并发症的高风险。
Objectives: As the number of patients with left ventricular assist device (LVAD) implantation has been increasing, treatment of LVAD-related ischemic stroke is becoming a critical issue. We sought to clarify the features of mechanical thrombectomy in LVAD-related stroke with large vessel occlusion.Methods: In a multi-center, retrospective case-control study, we compared 20 LVAD-related strokes with 33 nonLVAD strokes, all of which had large vessel occlusion in the anterior circulation treated with mechanical thrombectomy. A comparative histopathological examination of the retrieved thrombi was also performed.Results: Successful reperfusion was achieved in 75% of the LVAD-related strokes. The time from onset to reperfusion was similar to that of non-LVAD strokes, but the total number of device passes required for reperfusion (median, 2.5 versus 1, P = 0.01) and the incidences of post-procedural parenchymal and subarachnoid hemorrhage (25% versus 3%, P = 0.02 and 55% versus 15%, P = 0.01, respectively) were higher in LVAD-related strokes. Symptomatic intracranial hemorrhage occurred in 4 patients (20%) with LVAD-related strokes. The histopathological analysis revealed that the ratio of erythrocyte components was significantly lower in thrombi retrieved from patients with LVAD-related stroke than in those with non-LVAD stroke (19 +/- 6% versus 41 +/- 17%, P = 0.01).Conclusions: Mechanical thrombectomy is feasible in patients with LVAD-related stroke. However, repetitive device passes are needed to achieve successful reperfusion mainly because of the structurally organized thrombi, and the higher risk of hemorrhagic complications should be considered, while offering this therapeutic alternative.