第18巻 2022年4月　第2号

■症例報告

IMPELLA補助管理中に脳内出血をきたし開頭血腫除去術を施行した1例
古梅　香^{1, 2}, 中江　竜太¹, 中田　淳³, 五十嵐　豊¹, 増野　智彦¹, 山本　剛³, 横堀　將司^1
1日本医科大学付属病院高度救命救急センター
²和歌山県立医科大学附属病院麻酔科教室
³日本医科大学付属病院心臓血管集中治療科

A Case of Intracerebral Hemorrhage during IMPELLA Support and Craniotomy for Hematoma Removal
Kaori Kobai^{1, 2}, Ryuta Nakae¹, Jun Nakata³, Yutaka Igarashi¹, Tomohiko Masuno¹, Takeshi Yamamoto³ and Shoji Yokobori^1
1)Department of Emergency and Critical Care Medicine, Nippon Medical School
²⁾Department of Anesthesiology, Wakayama Medical University
³⁾Division of Cardiovascular Intensive Care, Nippon Medical School Hospital

IMPELLA^® (Abiomed) is a catheter-type left ventricular assist device (LVAD) with a built-in micro axial flow pump that removes blood from the left ventricle and delivers it to the ascending aorta. Use of this device for severe heart failure has recently increased. Here, we report a case of intracerebral hemorrhage occurring during the introduction of IMPELLA support which was successfully treated by craniotomy. The patient was a 23-year-old man who was admitted to another hospital with the diagnosis of low cardiac output syndrome associated with dilated cardiomyopathy. He was treated with respiratory management, including noninvasive positive pressure ventilation, and circulatory management with inotropic drugs and an intra-aortic balloon pump. His respiratory and circulatory condition worsened, however, and he was transferred to our hospital for advanced heart failure treatment. After admission, an IMPELLA CP was inserted via the right femoral artery and his hemodynamics were stabilized. However, weaning from the IMPELLA CP failed due to a lack of cardiac recovery, and ventricular support was escalated from the IMPELLA CP to IMPELLA 5.0 via the right subclavian artery. On the 36th day after admission, the patient suddenly developed intracerebral hemorrhage in the temporal and parietal lobes with midline shift, and craniotomy was performed under IMPELLA support. The postoperative course was good and he was able to walk with assistance. He was transferred to a rehabilitation hospital on the 105th day of hospitalization. Few reports of IMPELLA-related hemorrhagic stroke have appeared, and the incidence is not precisely known. To our knowledge, craniotomy under IMPELLA support has not been previously reported, and the accumulation of additional cases is required.

日医大医会誌 2022; 18(2), 212-215

Key words
Impella, ventricular assist device, anticoagulation, intracerebral hemorrhage, craniotomy

Correspondence to
Kaori Kobai, Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail：kobai.k.0910@gmail.com

受付：2022年1月13日　受理：2022年1月20日