Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report

BMC Cardiovascular Disorders
Walid OulehriPaul Michel Mertes

Abstract

Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy. A 39-year-old man presented with cardiogenic shock following an out-of-hospital cardiac arrest. After a period of stabilization, the patient was referred for LVAD placement. Upon recovery from anesthesia, he presented with acute neurological deficits suggestive of IS. A brain computed tomography confirmed the diagnosis, and an emergency decompressive hemicraniectomy (DHC) was performed. Anticoagulation was managed empirically. The patient's neurological status progressively improved and he was referred for heart transplantation at five months from DHC. One month later, cranioplasty was performed. This report suggests an anticoagulation management approach in combination with decompressive craniectomy after IS in a patient with LVAD placement was successful. An optimized anticoagulation management and collaborative team-based practice may contribute to successful outcomes in complex cases.

References

Aug 8, 2014·Surgical Neurology International·Mohammad Azman Mohammed RaffiqJafri Malin Abdullah
Nov 21, 2016·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Simon MaltaisUNKNOWN PREVENT Study Investigators
Jan 24, 2017·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Jennifer A FronteraNader Moazami
May 19, 2018·Journal of Cardiac Surgery·Muath BishawiCarmelo Milano

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Citations

Mar 12, 2021·Current Neurology and Neuroscience Reports·Aaron ShoskesSung-Min Cho

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