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The Impella was removed on postoperative day 2 at the bedside with local anaesthesia, and the graft ligated 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 CABG.<\/jats:p>","DOI":"10.1093\/icvts\/ivag149","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T11:37:49Z","timestamp":1778585869000},"source":"Crossref","is-referenced-by-count":0,"title":["Impella-Assisted Coronary Bypass With Massive Stroke From Aortic Side Arm Graft Thrombosis"],"prefix":"10.1093","volume":"41","author":[{"given":"Stephen D","family":"Waterford","sequence":"first","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery , Northwell, NY 11042,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J","family":"Cirbus","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Pittsburgh Medical Center , Jamestown, NY","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"2026061003311807000_ivag149-B1","doi-asserted-by":"crossref","first-page":"e373","DOI":"10.1016\/j.athoracsur.2020.09.069","article-title":"Impella 5.5 direct aortic implant and explant techniques","volume":"111","author":"Anderson","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"2026061003311807000_ivag149-B2","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1097\/MAT.0000000000001132","article-title":"Ischemic stroke and intracranial hemorrhages during Impella cardiac support","volume":"66","author":"Hassett","year":"2020","journal-title":"ASAIO J"},{"key":"2026061003311807000_ivag149-B3","doi-asserted-by":"crossref","first-page":"25402","DOI":"10.1038\/s41598-025-10555-4","article-title":"ECMO and Impella increase stroke risk in acute myocardial infarction","volume":"15","author":"Wu","year":"2025","journal-title":"Sci Rep."},{"key":"2026061003311807000_ivag149-B4","first-page":"1679:01756","article-title":"Hidden danger of microaxial flow pumps: five cases of aortic and innominate mural thrombi","author":"An","year":"2026","journal-title":"J Heart Lung Transplant."},{"key":"2026061003311807000_ivag149-B5","doi-asserted-by":"crossref","first-page":"S273","DOI":"10.1016\/j.healun.2022.01.672","article-title":"Long-term complications after support with Impella 5.0 and 5.5","volume":"41","author":"Lewin","year":"2022","journal-title":"J Heart Lung Transplant"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag149\/68280981\/ivag149.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/6\/ivag149\/68280981\/ivag149.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/6\/ivag149\/68280981\/ivag149.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T07:31:30Z","timestamp":1781076690000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivag149\/8677619"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":5,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,9]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag149","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,13]]},"article-number":"ivag149"}}