Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery

Abstract

Introduction Acute ischemic stroke (AIS) can be a catastrophic complication of cardiac surgery previously without effective treatment. Endovascular thrombectomy (EVT) is a potentially life‐saving intervention. We examined patients at our institution who had EVT to treat AIS post cardiac surgery. Methods We retrospectively reviewed a stroke database from January 1, 2016 to October 31, 2021 to identify patients who had undergone EVT to treat AIS following cardiac surgery. Demographic data, operation type, stroke severity, imaging features, management and outcomes (mortality and modified Rankin Score (mRS)) were assessed. Results Of 5022 consecutive patients with AIS, 870 underwent EVT. Seven patients (0.8%) had EVT following cardiac surgery. Operations varied: two coronary artery bypass grafting (CABG), two transcatheter AVR, one redo surgical aortic valve replacement (AVR), one mitral valve repair and one patient with combined aortic and mitral valve replacements and CABG. Meantime postsurgery to stroke symptoms onset was 3 days (range 0–9 days). Median NIHSS was 26 (range 10–32). Five patients had middle cerebral artery occlusion and two internal carotid artery (n = 2). Median time between onset of symptoms and recanalization was 157 min (range 97–263). Two patients received Intra‐arterial Thrombolysis. All patients survived and were discharged to another hospital (n = 3), home (n = 2), or rehabilitation facility (n = 2). Median 3‐month mRS was 3 (range 0–6). Conclusion We report the largest case series of EVT after cardiac surgery. EVT can be associated with excellent outcomes in these patients. Close neurological monitoring postoperatively to identify patients who may benefit from intervention is key.

Sensorineural hearing loss after cardiac surgery: a systematic review

“…Further research in this area may target the epidemiology, pathophysiology, prevention and treatment of cardiac surgery‐associated hearing loss 39 . In over 40 years since this issue was first described, Plasse et al .…”

“…Further research in this area may target the epidemiology, pathophysiology, prevention and treatment of cardiac surgery-associated hearing loss. 39 In over 40 years since this issue was first described, Plasse et al has been the only large-scale study looking at the incidence of this phenomenon. 9 In view of the changes in surgical procedures over the last 40 years, further studies are required to examine the incidence of hearing loss in the modern setting.…”

Endovascular Treatment of Acute Ischemic Stroke After Cardiac Interventions in the United States

“…However, data remain sparse on the use of endovascular thrombectomy (EVT) treatment for stroke after cardiac intervention, which is a critical knowledge gap: many patients are not eligible for intravenous thrombolytic treatment after cardiac surgery because of postsurgical hemorrhage risk . A 2020 meta-analysis found only 14 cases of EVT after cardiac surgery in the literature, a case series from 2021 had 6 patients, and another from 2022 had 7 patients. To bridge this knowledge gap and to better understand the rates of EVT after cardiac intervention, including surgery and percutaneous procedures, vs stroke hospitalizations without cardiac intervention, we conducted an analysis of data from a large administrative claims database.…”