Purpose of the Review

Short-term and durable mechanical circulatory support (MCS) devices represent life-saving interventions for patients with cardiogenic shock and end-stage heart failure. This review will cover the epidemiology, risk factors, and treatment of stroke in this patient population.

Recent Findings

Short-term devices such as intra-aortic balloon pump, Impella, TandemHeart, and Venoatrial Extracorporal Membrane Oxygenation, as well as durable continuous-flow left ventricular assist devices (LVADs), improve cardiac output and blood flow to the vital organs. However, MCS use is associated with high rates of complications, including ischemic and hemorrhagic strokes which carry a high risk for death and disability. Improvements in MCS technology have reduced but not eliminated the risk of stroke. Mitigation strategies focus on careful management of anti-thrombotic therapies. While data on therapeutic options for stroke are limited, several case series reported favorable outcomes with thrombectomy for ischemic stroke patients with large vessel occlusions, as well as with reversal of anticoagulation for those with hemorrhagic stroke.

Summary

Stroke in patients treated with MCS is associated with high morbidity and mortality. Preventive strategies are targeted based on the specific form of MCS. Improvements in the design of the newest generation device have reduced the risk of ischemic stroke, though hemorrhagic stroke remains a serious complication.

中文翻译：

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成人中风和机械循环支持

审查的目的

短期和持久的机械循环支持（MCS）设备代表了心源性休克和终末期心力衰竭患者的救生干预措施。本综述将涵盖该患者人群中风的流行病学、危险因素和治疗。

最近的发现

主动脉内球囊反搏器、Impella、TandemHeart 和静脉心房体外膜氧合等短期设备以及耐用的连续流左心室辅助设备 (LVAD) 可改善心输出量和重要器官的血流量。然而，MCS 的使用与高并发症发生率相关，包括缺血性和出血性中风，这些中风具有很高的死亡和残疾风险。MCS 技术的改进降低了中风风险，但并未消除。缓解策略的重点是仔细管理抗血栓治疗。虽然有关中风治疗选择的数据有限，但一些病例系列报道了对大血管闭塞的缺血性中风患者进行血栓切除术以及对出血性中风患者进行逆转抗凝治疗的良好结果。

概括

接受 MCS 治疗的患者中风的发病率和死亡率较高。根据 MCS 的具体形式制定有针对性的预防策略。最新一代设备设计的改进降低了缺血性中风的风险，尽管出血性中风仍然是一种严重的并发症。