Successful acute endovascular therapy of cerebral embolism for a patient with ventricular assist device: a case report

• Published in: Nō shinkei geka Vol. 42; no. 11; p. 1057
• Main Authors: Kobayashi, Satoshi, Miyamoto, Michiyuki, Shinada, Shinichiro, Ishi, Yukitomo, Shimoda, Yusuke, Yamazaki, Kazuyoshi, Ushikoshi, Satoshi, Ooka, Tomonori, Matsui, Yoshiro, Houkin, Kiyohiro
• Format: Journal Article
• Language: Japanese
• Published: Japan 01-11-2014
• Subjects: Female; Heart-Assist Devices; Humans; Infarction, Middle Cerebral Artery - diagnosis; Infarction, Middle Cerebral Artery - therapy; Intracranial Embolism - diagnosis; Intracranial Embolism - therapy; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Young Adult
• ISSN: 0301-2603
• DOI: 10.11477/mf.1436200033

The number of patients with a ventricular assist device(VAD)will increase with the spread of heart transplantation in Japan. On the other hand, it is likely that VADs could cause cerebral embolism. However, there are few reports about endovascular therapy for intracranial embolic infarction from VAD. The authors report successful acute endovascular therapy for cerebral embolism. A 19-year-old woman with a VAD who received anti-coagulant treatment by warfarin sodium presented disturbance of consciousness and right hemiparesis. CT scan showed early CT sign in the left middle cerebral artery (MCA) area. 3D-CTA demonstrated occlusion of the left MCA and basilar artery (BA). We first performed endovascular recanalization in the left MCA, because IV tPA was ineligible. The left MCA was recanalized with TICI 2b perfusion and her symptoms were significantly improved. The treatment of the VAD patient reveals important issues. First, the femoral puncture requires ultrasound due to pulseless femoral artery. Second, the access route is an intact artery because of the anatomy of the VAD. Third, even if the patient has a hemorrhagic complication by intervention, the patient must be kept on anti-coagulant treatment because the VAD requires it. Careful consideration should be given to recanalization of occlusive vessels.