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Successful intra-arterial thrombolytic therapy for a right middle cerebral artery stroke in a 2-year-old supported by a ventricular assist device
Authors:Byrnes Jonathan W  Williams Blake  Prodhan Parthak  Erdem Eren  James Charles  Williamson Randy  Gautam Nischal  Imamura Michiaki  Jaquiss Robert  Bhutta Adnan
Affiliation:Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, AR 72202, USA. byrnesjonathanw@uams.edu
Abstract:Embolic stroke is a common complication in patients on ventricular assist devices in both adults and children. The reported incidence of strokes in children supported by VAD's varies from 7 to 38%. The rapid increase in recent years in the availability of both adult and pediatric VADs will likely add to the overall prevalence of strokes in patients being bridged to heart transplant. Strokes in this population can be lethal as they frequently necessitate withdrawal of the extracorporeal device support and withdrawal from the organ transplant waiting list. We present a case of a fully anti-coagulated 29-month-old supported on a Berlin EXCOR LVAD (Berlin, Germany) with embolic stroke which was treated successfully with direct thrombolysis with recombinant tissue plasminogen activator. This is the first report which uses intra-arterial thrombolytics while on a ventricular assist device in a pediatric patient.
Keywords:acute stroke  Berlin EXCOR  embolic stroke  pediatric stroke  thrombolysis  ventricular assist device
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