• Bikei Ryu, Tatsuya Ishikawa, Koji Yamaguchi, Go Matsuoka, Seiichiro Eguchi, and Takakazu Kawamata.
• Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. ryu.bikei@twmu.ac.jp.
• Acta Neurochir (Wien). 2018 Sep 1; 160 (9): 1729-1735.

BackgroundLeft ventricular assist devices (LVADs) were developed for the treatment of patients with severe heart failure (HF) as a bridge to heart transplantation (HT). Although long-term LVAD support results in substantial improvements, their long-term use often leads to severe acute ischemic stroke (AIS). Serious neurological events make it difficult to continue LVAD support, and these patients are excluded as candidates for HT. AIS remains a challenging problem in patients receiving LVAD support. Recently, although thrombectomy has been established in selected patients who are independent, it has not been established in patients who are not completely independent, such as those with LVAD support.MethodsWe describe four AIS patients with severe HF who were implanted with an LVAD as a bridge to HT. Five mechanical thrombectomies were performed for AIS associated with an LVAD in four patients. A literature review is presented and compared to the present results.ResultsGood recanalization was achieved in all patients. In three cases, marked neurological improvement was observed, and modified Rankin Scale (mRS) scores were maintained without deterioration. The median total follow-up period was 592 days. In one patient, HT was successfully performed after thrombectomy. Currently, two of the patients without neurological deficits are awaiting HT.ConclusionsEmbolism is a major problem encountered by patients under LVAD support while waiting for an HT. Thrombectomy for AIS associated with LVAD support is a useful and safe treatment modality. It is possible to maintain a reasonable mRS score in patients who are not completely independent.

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