Intraarterial mechanical thrombectomy for the treatment of postoperative cerebral infarction: a case report

Yun, Jong-Won; Ahn, So Woon; Kim, Yong-Ho; Min, Jinhye; Choi, Yun-Woong; Chae, Young Keun; Lee, Eun Sang; Kang, Yoo Jin

doi:10.4097/kjae.2014.66.5.402

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…Since the use of thrombolysis during peri-operative period is contraindicated and strokes were linked to increased mortality, mechanical cerebral thrombectomy has been an emergent procedure to improve the neurological outcomes [ 47 , 48 ]. The experience of postoperative cerebral thrombectomy is limited to few case reports [ 49 , 50 ]. In our heart center, we decreased the use of narcotic analgesia and deep sedation immediately after cardiac surgery for close neurological assessment and early detection of any focal sign of neurological impairment.…”

Section: Discussionmentioning

confidence: 99%

Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes

et al. 2022

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Background Despite the improved medical and surgical managements, still there is a significant risk of developing acute cerebrovascular strokes after coronary artery bypass grafting (CABG). Our objectives were to study the immediate and long-term outcomes after CABG and to identify the possible predictors of post-CABG strokes. Results Between January 2016 and August 2020, 410 adult patients, mostly males (82.2%), were retrospectively enrolled after CABG. Acute postoperative strokes occurred in 31 (7.5%) patients; of them, 30 (96.8%) patients had ischemic stroke, while 1 (3.2%) had hemorrhagic stroke. Mechanical thrombectomy was done in two cases. The patients who developed acute cerebral stroke had significantly higher admission (p = 0.02) and follow-up (p < 0.001) SOFA scores, higher arterial blood lactate level (p < 0.001), longer hospitalization (p < 0.001) and more hospital mortality (p < 0.001) compared with the patients who did not develop stroke. Kaplan–Meier curves for 5-year mortality showed increased risk in those patients with postoperative stroke (HR: 23.03; 95% CI: 6.10–86.92, p < 0.001). After multivariate regression, the predictors of early postoperative stroke were carotid artery stenosis (CAS), postoperative atrial fibrillation, cardiopulmonary bypass time, prior cerebral stroke, admission SOFA score and chronic kidney disease (CKD). The predictors of late cerebrovascular stroke were CAS, combined CABG and valve surgery, CKD, atrial fibrillation, prior stroke and HbA1c. Conclusions The development of post-CABG acute cerebrovascular stroke is associated with longer hospitalization, multiple morbidities and increased mortality. Careful assessment and management of risk factors especially atrial fibrillation and carotid artery stenosis should be implemented to decrease this substantial complication after CABG.

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Section: Discussionmentioning

confidence: 99%

Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes

et al. 2022

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“…1,3 In the immediate postoperative patient population, experience with mechanical thrombectomy is very limited with only a handful of cases reported. [4][5][6] (a Unfortunately, this service is not widely available, but is currently being commissioned to provide a service not dissimilar to the percutaneous coronary intervention services that now exist for acute myocardial infarction. Mechanical thrombectomy is currently indicated for the management of acute ischaemic stroke with proximal large artery occlusion of the anterior circulation in a patient in whom the procedure can be performed within six hours of symptom onset, although some recent studies extend selection of patients up to 24 hours following symptom onset if CT perfusion-based criteria can be met.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for the treatment of acute ischaemic stroke following pulmonary lobectomy

Wolff

Falconieri

et al. 2019

annals

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Acute ischaemic stroke is a devastating postoperative complication that significantly impacts upon a patient’s quality of life. Endovascular retrieval of thromboembolic material from proximal cerebral arteries by mechanical thrombectomy is the new standard of care for patients presenting with a proximal artery occlusion. We report the case of a patient developing an acute ischaemic stroke following pulmonary lobectomy, who was transferred to the regional neurosciences unit, despite the absence of an established referral pathway, to undergo mechanical thrombectomy, with significant prognostic neurological benefit. We would advocate all cardiothoracic centres identify their regional neurosciences unit and initiate discussion to establish a referral pathway.

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“…The advent of endovascular mechanical thrombectomy [5] has surely added to the neurosurgical armamentarium. Perioperative vascular studies such as DSA/MRA/CTA may be considered to rule out worsening of stenosis after surgery or to rule out a thrombotic phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Delayed proximal middle cerebral artery thrombosis after middle cranial base meningioma resection: a lesson to learn

et al. 2015

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# Springer-Verlag Wien (outside the USA) 2015Sir, Perioperative stroke can lead to unforeseen complications. Prompt diagnosis and endovascular management can halt the progressive neurological deficit or even reverse it. We illustrate a case of delayed arterial thrombosis after resection of a skull base meningioma in spite of proven patency of the vessel with intraoperative indocyanine green angiography. To our knowledge this is the second report of such an event. CaseThis 70-year-old male presented with headache and memory loss for 8 months. The patient had a past history of bilateral pulmonary embolism 6 months previously and was treated medically. He is a known case of atrial fibrillation and on regular warfarin. However, a recent chest CT and cardiac echocardiography were normal. Magnetic resonance imaging revealed a solitary mass along the base of middle cranial fossa (5.2×3×4.1 cm), enhancing, in the left middle cranial fossa extending medially and superiorly to the left parasellar and suprasellar region, encasing the cavernous carotid and middle cerebral artery (MCA) (Fig. 1). He underwent left-sided frontotemporal craniotomy using an orbito-zygomatic approach and gross total resection. The tumor was vascular and densely adhered to the middle cerebral artery and its perforators. However, with meticulous dissection, the MCA trunk and its perforators were skeletonized. An ICG angiogram showed patency of the middle cerebral artery. The patient was extubated and taken to the ICU; he was started on aspirin and warfarin on postoperative day (POD) 2. On POD 3, the patient noted the development of slurring of speech and right-sided weakness. He was evaluated with a CT of the head, which revealed evolving left-sided ischemic stroke. The patient was taken for a four-vessel angiogram. Thrombotic occlusion of the left M1 segment with>70 % stenosis was noted. The intervention was initiated within 3 h of the onset of deficit. The patient underwent successful mechanical thrombectomy using a stent retriever, obtaining TICI 2B reperfusion. Post-procedure, the patient recovered well. The patient was discharged with right-side hemiparesis and expressive aphasia. Follow-up was available for 3 months. The patient had residual

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Intraarterial mechanical thrombectomy for the treatment of postoperative cerebral infarction: a case report

Cited by 3 publications

References 15 publications

Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes

Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes

Mechanical thrombectomy for the treatment of acute ischaemic stroke following pulmonary lobectomy

Delayed proximal middle cerebral artery thrombosis after middle cranial base meningioma resection: a lesson to learn

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