314 Radiographic Risk Factors for Intracranial Hemorrhage in Patients with Left Ventricular Assist Devices

INTRODUCTION: Intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVAD) is a complication with significant morbidity and mortality. Many studies have identified demographic risk factors for ICH in LVAD patients; however, anatomic pre-disposition to ICH in these patients has not yet been investigated. METHODS: We reviewed 440 patients who received an LVAD at our institution. We then selected patients who received CT scans of the head for any reason near the time of LVAD placement. 288 patients (21 ICH, 278 Control) with CT scans were included in the analysis. A detailed chart review was then performed to collect data on patient demographics, radiographic findings, and complications. RESULTS: The incidence of ICH in our complete cohort was 8.6% (38/440). The presence of pump thrombosis (p = 0.001), driveline infection (p = 0.034), other hemorrhage (p = 0.001), or previous placement of a cardio-defibrillator (p = .003) during the period of LVAD implantation was associated with increased risk for ICH. An analysis of patient imaging revealed that the presence of a mass (p = 0.006), vascular malformation (p = 0.001), and microangiopathy (p = 0.04) was significantly associated with ICH in LVAD patients. We further validated the significance of these radiographic features using a multivariate logistic regression which showed that the presence of a mass (aOR 332.1, 95% CI: 14.7-7485.1, p < 0.001), vascular malformation (aOR 69.7, 95% CI: 1.8-2658.8, p = 0.022), and microangiopathy (aOR 6.5, 95% CI: 1.1-37.6, p = 0.035) were independently associated with ICH. CONCLUSIONS: Radiographic evidence of microangiopathy, intracranial mass, and vascular malformation are independent risk factors for ICH which may be identified at or before the time of LVAD implantation. We advocate that CT imaging may be used to further stratify patients at highest risk of ICH during treatment with an LVAD.