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 non-LVAD 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.

中文翻译：

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急性缺血性脑卒中患者应用左心辅助装置机械取栓

目标随着左心室辅助装置 (LVAD) 植入患者的数量不断增加，LVAD 相关缺血性卒中的治疗正成为一个关键问题。我们试图阐明机械取栓术在伴有大血管闭塞的 LVAD 相关卒中中的特征。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，所有这些卒中均在前循环中存在大血管闭塞，并采用机械取栓治疗。还对取回的血栓进行了比较组织病理学检查。结果 75% 的 LVAD 相关卒中成功再灌注。从发病到再灌注的时间与非 LVAD 卒中相似，但再灌注所需的器械通过总数（中位数，2.5 比 1，P = 0.01）和术后实质和蛛网膜下腔出血的发生率（分别为 25% 对 3%，P = 0.02 和 55% 对 15%，P = 0.01）在 LVAD 相关中风中更高。4 名 LVAD 相关卒中患者 (20%) 出现症状性颅内出血。组织病理学分析显示，与非 LVAD 卒中患者相比，LVAD 相关卒中患者提取的血栓中红细胞成分的比例显着降低（19 ± 6% vs 41 ± 17%，P = 0.01）。结论 LVAD 相关卒中患者机械取栓是可行的。然而，主要是因为结构上有组织的血栓，需要重复的设备通过才能实现成功的再灌注，并且在提供这种治疗选择的同时，应考虑出血并发症的较高风险。