Abstract
Introduction
The significance of microembolic signals (MES) detected by transcranial Doppler ultrasound
emboli monitoring (TCD-e) in patients supported with left ventricular assist devices
(LVAD) remains unclear. We aimed to investigate the relationship between cerebral
microembolization detected by TCD-e and acute ischemic events in LVAD patients.
Methods
We reviewed consecutive patients with acute ischemic stroke or transient ischemic
attack (TIA) in a prospectively collected database of LVAD patients. TCD-e exams consisted
of monitoring the middle cerebral arteries for microembolic signals (MES) over 30
minutes.
Results
Of 515 persons with LVAD, 41 TCD-e studies were performed in 35 patients with acute
ischemic stroke or transient ischemic attack (TIA) in a median of 1 day (Interquartile
range [IQR]: 0-2) after the event. MES were present in 15 (44%) TCD-e studies with
a median MES count of 4 (IQR: 2-15.5). Bloodstream infections were more common in
patients with MES (38% versus 8%, P = .039). There were trends for lower international normalized ratio (1.39 versus
1.69, P = .214), lower activated partial thromboplastin (33.2 versus 36.6, P = .577), higher lactate dehydrogenase (531 versus 409, P = .323) and a higher frequency of pump thrombosis (13% versus 8%, P = .637) in patients with MES compared with those without MES.
Conclusions
LVAD patients with acute ischemic stroke or TIA have a high prevalence of MES on TCD-e,
which may serve as a marker for a prothrombotic state. Further study of MES in LVAD
patients is warranted.
Key Words
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Article info
Publication history
Published online: February 07, 2020
Accepted:
January 10,
2020
Received in revised form:
January 9,
2020
Received:
October 11,
2019
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104660
Copyright
© 2020 Elsevier Inc. All rights reserved.
