echanical thrombectomy in acute ischemic stroke patients with a left ventricular assist device

2021 Fiscal Year Final Research Report

• Project/Area Number: 19K20729
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 90140:Medical technology assessment-related
• Research Institution: Osaka University
• Principal Investigator: KITANO TAKAYA 大阪大学, 医学系研究科, 招へい教員 (70772193)
• Project Period (FY): 2019-04-01 – 2022-03-31
• Keywords: 血栓 / 人工心臓 / 脳卒中 / 脳梗塞 / 塞栓 / 血栓回収 / 再開通 / 線溶

Outline of Final Research Achievements

As the number of patients with left ventricular assist device (LVAD) implantation has been increasing, treatment of LVAD-related ischemic stroke is becoming a critical issue. We sought to clarify the features of mechanical thrombectomy in LVAD-related stroke with large vessel occlusion. In a multi-center, retrospective case-control study, we compared 20 LVAD-related strokes with 33 non-LVAD strokes, all of which had large vessel occlusion in anterior circulation treated with mechanical thrombectomy. A comparative histopathological examination of the retrieved thrombi was also performed. Mechanical thrombectomy is feasible in patients with LVAD-related stroke. However, repetitive device passes is needed to achieve successful reperfusion mainly because of the structurally organized thrombi, and the higher risk of hemorrhagic complications should be considered, while offering this therapeutic alternative.

Free Research Field

神経内科

Academic Significance and Societal Importance of the Research Achievements

臓器移植の限られている本邦において、人工心臓は重症心不全において非常に重要な治療法の一つである。一方で、人工心臓装着患者は脳梗塞を発症するリスクが高く、脳梗塞後遺症が問題となっていた。近年、脳梗塞の治療法としてカテーテルを用いて血栓を脳血管から取り除く血栓回収術が可能となった。人工心臓を装着していても安全にこの治療を行うことが出来るのかは明らかでなかったため、本研究はこれまでの最大の症例数を集めて解析し、人工心臓装着患者でも血栓回収術が有用なことを示した。ただし、一般の患者よりもLVAD装着患者では周術期の出血性合併症が多く、慎重な治療を要することも明らかとなった。