Singh Arushi, Ali Syed Zain, Drozdowicz Kelly A, Alam Amit, Goldberg Randal I, Chan Justin C, Leacche Marzia, Moazami Nader, Reyentovich Alex, Kadosh Bernard S
Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA.
Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA.
JACC Case Rep. 2025 Apr 2;30(7):103378. doi: 10.1016/j.jaccas.2025.103378.
The authors present the case of a young man who presented with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation and microaxial flow pump complicated by acute spinal cord infarction (SCI) leading to bilateral lower extremity paraplegia.
The key questions included the following: 1) What is the incidence and pathophysiology for SCI with mechanical circulatory support (MCS)?; 2) Which configurations of MCS carry a greater risk of SCI? How do we approach MCS escalation, recognizing that with each device we carry additive risk of complications?; 3) What data guide anticoagulation strategies for MCS?; and 4) What strategies can we implement to support patients who have suffered SCI from MCS?
Our patient was transitioned to a right ventricular assist device with Impella 5.5 as a bridge to therapy, and underwent cardiac transplantation 4 weeks after presentation with ongoing inpatient rehabilitation.
TAKE-HOME MESSAGES: Contemporary MCS carries a small but significant risk of SCI which is often irreversible. More data are required to guide anticoagulation strategies for MCS and mitigate risk.
作者介绍了一名年轻男性的病例，该患者出现心源性休克，需要静脉-动脉体外膜肺氧合和微轴流泵支持，并发急性脊髓梗死（SCI），导致双下肢截瘫。
关键问题包括以下几点：1）机械循环支持（MCS）患者发生SCI的发生率及病理生理学是什么？2）哪种MCS配置导致SCI的风险更高？鉴于每种设备都会增加并发症风险，我们应如何进行MCS升级？3）哪些数据可指导MCS的抗凝策略？4）对于因MCS导致SCI的患者，我们可以实施哪些策略来支持他们？
我们的患者被过渡到使用Impella 5.5右心室辅助装置作为治疗桥梁，并在就诊后4周接受了心脏移植，同时持续进行住院康复治疗。
当代MCS导致SCI的风险虽小但显著，且通常不可逆。需要更多数据来指导MCS的抗凝策略并降低风险。
