Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report
Abstract Background Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy. Case presentation A 39-year-old man presented with cardio...
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doaj-697077e301f04d888d44bd276904c2102020-11-25T03:38:19ZengBMCBMC Cardiovascular Disorders1471-22612020-06-012011410.1186/s12872-020-01576-0Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case reportWalid Oulehri0Mircea Cristinar1Gharib Ajob2Sandrine Marguerite3Bob Heger4Hélène Cebula5Michel Kindo6Paul Michel Mertes7Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHCPôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHCPôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHCPôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHCPôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHCPôle Tête et Cou, service de Neurochirurgie, Hôpitaux Universitaires de Strasbourg NHCEA 3072, Fédération de Médecine Translationnelle de Strasbourg, Institut de Physiologie, Université de StrasbourgPôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHCAbstract Background Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy. Case presentation A 39-year-old man presented with cardiogenic shock following an out-of-hospital cardiac arrest. After a period of stabilization, the patient was referred for LVAD placement. Upon recovery from anesthesia, he presented with acute neurological deficits suggestive of IS. A brain computed tomography confirmed the diagnosis, and an emergency decompressive hemicraniectomy (DHC) was performed. Anticoagulation was managed empirically. The patient’s neurological status progressively improved and he was referred for heart transplantation at five months from DHC. One month later, cranioplasty was performed. Conclusions This report suggests an anticoagulation management approach in combination with decompressive craniectomy after IS in a patient with LVAD placement was successful. An optimized anticoagulation management and collaborative team-based practice may contribute to successful outcomes in complex cases.http://link.springer.com/article/10.1186/s12872-020-01576-0Decompressive craniectomyCardiac arrestLeft ventricular assist deviceIschemic strokeAnticoagulationHeart transplantation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Walid Oulehri Mircea Cristinar Gharib Ajob Sandrine Marguerite Bob Heger Hélène Cebula Michel Kindo Paul Michel Mertes |
spellingShingle |
Walid Oulehri Mircea Cristinar Gharib Ajob Sandrine Marguerite Bob Heger Hélène Cebula Michel Kindo Paul Michel Mertes Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report BMC Cardiovascular Disorders Decompressive craniectomy Cardiac arrest Left ventricular assist device Ischemic stroke Anticoagulation Heart transplantation |
author_facet |
Walid Oulehri Mircea Cristinar Gharib Ajob Sandrine Marguerite Bob Heger Hélène Cebula Michel Kindo Paul Michel Mertes |
author_sort |
Walid Oulehri |
title |
Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report |
title_short |
Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report |
title_full |
Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report |
title_fullStr |
Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report |
title_full_unstemmed |
Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report |
title_sort |
decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report |
publisher |
BMC |
series |
BMC Cardiovascular Disorders |
issn |
1471-2261 |
publishDate |
2020-06-01 |
description |
Abstract Background Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy. Case presentation A 39-year-old man presented with cardiogenic shock following an out-of-hospital cardiac arrest. After a period of stabilization, the patient was referred for LVAD placement. Upon recovery from anesthesia, he presented with acute neurological deficits suggestive of IS. A brain computed tomography confirmed the diagnosis, and an emergency decompressive hemicraniectomy (DHC) was performed. Anticoagulation was managed empirically. The patient’s neurological status progressively improved and he was referred for heart transplantation at five months from DHC. One month later, cranioplasty was performed. Conclusions This report suggests an anticoagulation management approach in combination with decompressive craniectomy after IS in a patient with LVAD placement was successful. An optimized anticoagulation management and collaborative team-based practice may contribute to successful outcomes in complex cases. |
topic |
Decompressive craniectomy Cardiac arrest Left ventricular assist device Ischemic stroke Anticoagulation Heart transplantation |
url |
http://link.springer.com/article/10.1186/s12872-020-01576-0 |
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