¹Departments of Cardiovascular Surgery, Şişli Florence Nightingale Hospital, İstanbul
²Neurology, İstanbul Florence Nightingale Hospital, İstanbul
³Invasive Radiology, Şişli Florence Nightingale Hospital, İstanbul DOI : 10.9739/uvcd.2014-39430 We report a 57-year-old lady who had been suffering from advanced heart failure for mo- re than 3 years under maximal medical therapeutic treatment, and had left ventricular assist device im- plantation (LVAD) due to exacerbation of her heart failure. She was New York Heart Association Class IV and Interagency Registry for Mechanically Assisted Circulatory Support level I. She had HeartWare LVAD implantation and recovered well after the postoperative period. She was admitted to emergency department with headache, vertigo, neck and occipital pain in the postoperative 4th month. She could not have magnetic resonance imaging since she had cardioverter defibrillator implantation(CRT-D). Her kranial computerized tomography (CT) reported a small right thalamic infarct which was treated with medical therapy. Twenty days later after the first event, she was admitted to emergency unit with dysarthria, dysphasia, right paresthesia and truncal ataxia. She had CT angiography, and was reported as right vertebral artery dissection which is an uncommon cause of mild and significant trauma. Our patient co- uld not have benefit from endovascular management since posterior inferior cerebellar artery supply would be affected, and possible infarct might occur. The only accepted medical therapy was management of possible ischemic stroke by anti-coagulation or by anti-platelet therapy. Our current case shows that the neurologic symptoms patients with LVAD may not be only due to pump thrombosis or malfunction of the LVAD. We report the first case in the literature with advanced heart failure supported with LVAD and diagnosed with extracranial right vertebral artery dissection. Keywords : Heart-assist devices; carotid artery diseases; endovascular procedures