Impella-assisted coronary bypass with massive stroke from aortic side arm graft thrombosis

Abstract A 59 year old man with an ejection fraction of 20% underwent off-pump coronary artery bypass grafting with an Impella 5.5 placed through a side arm graft to the ascending aorta tunneled to the left neck. The Impella was removed on postoperative day 2 at the bedside with local anesthesia and the graft oversewn at the skinligated at the level of the skin. The patient was discharged on postoperative day 6 with no complications. He returned on postoperative day 184 with a large left cerebral stroke, with computed tomography angiography showing thrombus in the remnant graft extending into the ascending aorta, wrapping around the aortic arch and going into the left common carotid artery. He required hemicraniectomy and prolonged rehabilitation. This report serves to raise awareness of this complication and provides a discussion on the use of Impella assistance for coronary artery bypass grafting.