Successful Acute Endovascular Therapy of Cerebral Embolism for a Patient with Ventricle-assist Device: Case Report

Abstract

Objective: Ventricular assist devices (VAD) are used as a bridge to heart transplantation. Cerebral embolism can develop in patients with VADs despite a strict anticoagulation therapy. We report two cases of successful acute endovascular therapy with Penumbra system for cerebral embolism.Case Presentations: Case 1: A 20-year-old woman with a VAD presented with right facial palsy and right monoparesis. 3D-computed tomography angiography (3D-CTA) demonstrated left middle cerebral artery (MCA) occlusion. We successfully performed endovascular recanalization of the left MCA with Thrombolysis in Cerebral Infarction (TICI) Grade3 perfusion, and the patient’s symptoms significantly improved. The patient’s condition improved to nearly the pre-treatment state. However, due to repeated strokes, the patient developed disturbances of consciousness, aphasia, and complete paralysis of the left lower limb. Furthermore, the infection worsened, and the patient eventually developed a circulatory disorder of the VAD and died. Case 2: A 34-year-old man with VAD presented with sudden disturbances of consciousness and right hemiparesis. Computed tomography (CT) scan revealed no early abnormalities. We performed endovascular recanalization of the left internal carotid artery (IC) top with TICI 3 perfusion. After endovascular treatment, CT scan did not reveal a cerebral infarction. The patient eventually achieved an National Institutes of Health Stroke Scale (NIHSS) score of 0 point and received a heart transplant. In case 2, we pathologically analyzed the retrieved thrombus and confirmed the thrombus to be mainly composed of fibrin. There were no complications of hemorrhage in either case.Conclusion: A suction-type thrombectomy device is believed to be the first choice for patients with VAD.