Mechanical thrombectomy after acute ischemic stroke in patients with left ventricular assist devices: A nationwide analysis

Abstract

Introduction Left ventricular assist devices (LVADs) are an established, durable and lifesaving treatment option for patients with advanced heart failure. However, large vessel occlusions (LVOs) remain one of its most devastating embolic complications. Mechanical thrombectomy (MT) is safe and effective in the management of LVOs in the general population but LVO trials largely excluded patients on mechanical circulatory support and large-scale analyses of outcomes following these interventions in the LVAD population are lacking. Methods Using the National Inpatient Sample, we identified all adult patients hospitalized with acute ischemic stroke (AIS) from 2005-2018. Regression models adjusting for patient demographics, hospital factors, and clinical severity were used to compare outcomes following MT in patients with and without LVAD. Subgroup analyses were also performed in LVAD patients experiencing stroke in the post-operative setting and stroke in the setting of pre-existing devices. Results Of the 1,633,234 AIS hospitalizations identified, 794 occurred in patients with LVADs. 61% were postoperative. Post-stroke in-hospital mortality was higher among patients with LVADs (23.3% vs 7.23%, P<0.001). Among those receiving MT, mortality was also higher in the LVAD population (31.0% vs 14.1%, P=0.009), though this was largely driven by the post-operative LVAD subgroup. In multivariable analysis, only post-operative LVAD patients experienced greater odds of in-hospital death after MT (aOR: 8.66, CI:1.46-51.3); patients with pre-existing LVADs demonstrated no difference in post-MT mortality (aOR: 1.06; 95% CI: 0.29-3.91) or in odds of discharge home after MT (aOR 0.63, CI: 0.17-2.32) Conclusion Our data suggests MT is not a futile treatment approach in patients with pre-existing LVADs and may result in similar rates of good outcomes. Additional research is needed to evaluate the long-term benefits of endovascular therapy after stroke in patients on LVAD support.

The diversity of global stroke research in the IJS

“…Ibeh and colleagues used the US National Inpatient Sample to identify 794 of 1,633,234 acute ischemic stroke hospitalizations which occurred in patients with LVADs. 28 Over half (61%) were post-operative. Although post-stroke in-hospital mortality was higher among patients with LVADs (23.3% vs 7.23%), on multivariable analysis, only post-operative LVAD patients experienced a greater odds of in-hospital death after MT, while patients with pre-existing LVADs demonstrated no difference in post-MT mortality (aOR = 1.06; 95% CI, 0.29-3.91) or in odds of discharge home after MT (aOR = 0.63, CI, 0.17-2.32).…”