2022 Volume 18 Issue 2 Pages 212-215
IMPELLA® (Abiomed) is a catheter-type left ventricular assist device (LVAD) with a built-in micro axial flow pump that removes blood from the left ventricle and delivers it to the ascending aorta. Use of this device for severe heart failure has recently increased. Here, we report a case of intracerebral hemorrhage occurring during the introduction of IMPELLA support which was successfully treated by craniotomy. The patient was a 23-year-old man who was admitted to another hospital with the diagnosis of low cardiac output syndrome associated with dilated cardiomyopathy. He was treated with respiratory management, including noninvasive positive pressure ventilation, and circulatory management with inotropic drugs and an intra-aortic balloon pump. His respiratory and circulatory condition worsened, however, and he was transferred to our hospital for advanced heart failure treatment. After admission, an IMPELLA CP was inserted via the right femoral artery and his hemodynamics were stabilized. However, weaning from the IMPELLA CP failed due to a lack of cardiac recovery, and ventricular support was escalated from the IMPELLA CP to IMPELLA 5.0 via the right subclavian artery. On the 36th day after admission, the patient suddenly developed intracerebral hemorrhage in the temporal and parietal lobes with midline shift, and craniotomy was performed under IMPELLA support. The postoperative course was good and he was able to walk with assistance. He was transferred to a rehabilitation hospital on the 105th day of hospitalization. Few reports of IMPELLA-related hemorrhagic stroke have appeared, and the incidence is not precisely known. To our knowledge, craniotomy under IMPELLA support has not been previously reported, and the accumulation of additional cases is required.
