title: Neuroendovascular Interventions for Acute Ischemic Strokes in Patients Supported with Left Ventricular Assist Devices: A Single-Center Case Series and Review of the Literature.
abstract: BACKGROUND
  With the shortage of donor hearts, increasingly more patients with end-stage heart failure are implanted with left ventricular assist devices (LVADs). LVADs are associated with a significant risk of developing acute ischemic strokes (AISs). Very little is known on about the management of AIS in patients with LVAD, especially with regard to the safety and efficacy of neuroendovascular techniques.
  
  
  METHODS
  We identified 5 patients with heart failure and LVAD implants who developed AIS and underwent neuroendovascular interventions at Columbia University Medical Center. Their cases were reviewed for the safety, efficacy of the interventions, and potential complications.
  
  
  RESULTS
  There were no significant complications from the interventions. In all 5 cases, there was at least a 4-point improvement in the National Institutes of Health Stroke scale and none of the cases developed symptomatic hemorrhage. Two patients had substantial improvement and received cardiac transplantations.
  
  
  CONCLUSIONS
  Neuroendovascular intervention is safe and feasible in patients with LVAD and may potentially contribute to improving the outcome of a disease that has a poor natural history. Further study is recommended.
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York, USA. Electronic address: fawazalmufti@outlook.com.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bauerschmidt
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York, USA; Department of Neurosurgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, New York, New York, USA; Department of Radiology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
authors.affiliation: Department of Internal Medicine-Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
mesh_terms: D000328:Adult; D000368:Aged; D015984:Causality; D015897:Comorbidity; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000517:prevention & control*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ischemic stroke; Left ventricular assist device; mechanical thrombectomy