Successful interventional thrombectomy of a basilar artery thrombus in a long-term LVAD patient.

Cerebral thromboembolism builds the Achilles heel for patients on left ventricular support (LVAD). Thrombolytic therapy is usually contraindicated considering the increased risk of intracranial hemorrhage in patients with LVAD under therapeutic oral anticoagulation with concomitant platelet inhibition. We report on an alternative approach to this dilemma. On day 1,091 of LVAD support (INCOR Berlin Heart), a 69 year-old male patient was admitted to a rural hospital unconscious with a left-sided hemiplegia. Cerebral computed tomography (CT) with CT angiography revealed a thromboembolic distal basilar artery occlusion. The patient was immediately transported to our medical center, where an interventional thrombectomy restored full patency of the vessel. The patient recovered without neurologic sequelae within days. This case highlights the fact that patients on LVAD support with a neurologic event should be immediately transferred to a neurovascular center for appropriate treatment including a neurointervention.