Cerebral infarction and hemorrhage are among the principal sources of morbidity and mortality associated with mechanical circulatory support. There has been particular concern with the recently reported increased rate of device thrombosis in continuous-flow left ventricular assist devices. The neurologic management of stroke among these patients has limited data to inform current clinical practices. In this investigation we review the available literature on stroke in patients with continuous-flow left ventricular assist devices, with a focus on treatment algorithms in the acute setting and for secondary stroke prevention. © 2014 International Society for Heart and Lung Transplantation.