Highlights
- •Most LVAD patients have available head imaging which may be reviewed
- •LVAD patients are high risk for ICH based on radiographic features on head CT
- •Masses, vascular pathology, and microangiopathy predict intracranial hemorrhage
- •A screening head CT may identify high-risk patients for ICH with LVADs
- •Complete risk stratification with imaging allows medical optimization against ICH
Abstract
Objective
Intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVAD)
is a devastating complication. Demographic risk factors for ICH in LVAD patients are
defined, however anatomic predispositions to ICH are unknown. We sought to interrogate
intracranial radiographic risk factors for ICH in LVAD patients.
Methods
We reviewed 440 patients who received an LVAD from 2008-2021. We selected patients
with CT scans of the head either before or after LVAD placement, but typically within
5 years. 288 patients (21 ICH, 267 Control) with imaging were included. A detailed
chart review was performed on demographics, radiographic features, and management.
Results
The incidence of ICH in our total cohort was 8.6% (38/440). The presence of pump thrombosis
(p=0.001), driveline infection (p=0.034), other hemorrhage (p=0.001), or previous
placement of a cardio-defibrillator (p=.003) was associated with increased risk for
ICH. An analysis of imaging revealed that the presence of a mass (p=0.006), vascular
pathology (p=0.001), and microangiopathy (p=0.04) was significantly associated with
ICH in LVAD patients. These radiographic features were validated with a multivariate
logistic regression which confirmed presence of a mass (aOR 332.1, 95% CI: 14.7-7485.1,
p<0.001), vascular pathology (aOR 69.7, 95% CI: 1.8-2658.8, p=0.022), and microangiopathy
(aOR 6.5, 95% CI: 1.1-37.6, p=0.035) were independently associated with ICH.
Conclusion
Radiographic evidence of microangiopathy, intracranial mass, and vascular pathology
are independent risk factors for ICH which are readily identified by imaging. We advocate
that CT imaging be used to further stratify patients at highest risk of ICH during
treatment with an LVAD.
Keywords
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Article Info
Publication History
Published online: November 01, 2022
Accepted:
October 26,
2022
Received in revised form:
October 17,
2022
Received:
July 31,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106869
Copyright
© 2022 Elsevier Inc. All rights reserved.
