Mechanical thrombectomy in ischemic stroke after cardiovascular procedures: a propensity-matched cohort analysis

Abstract

BackgroundStroke after a cardiovascular procedure (CVP) is a devastating complication adversely affecting outcome. Mechanical thrombectomy (MT) has not been investigated systematically in this population.ObjectiveTo carry out a retrospective study in patients undergoing MT for early stroke after CVP, aiming to further characterize this cohort of patients, and to evaluate the efficacy, safety, procedural characteristics, and outcome of MT.MethodsA single-center stroke registry of patients who received MT was analyzed. Baseline and procedural parameters, mortality, functional outcome, recanalization rates, and complications were evaluated. Propensity score matching was carried out, identifying a control cohort with non-periprocedural large vessel occlusion (LVO).ResultsOverall 913 patients were included (mean age 73.0 (±13.0) years, 52.5% female, median National Institutes of Health Stroke Scale score 15 (10–19)). Eleven patients with a LVO after a recent (<30 days postoperatively) CVP were identified (n=3 transcatheter aortic valve and n=1 surgical aortic valve replacements (SAVR), n=3 coronary bypass grafting (CABG) surgeries, n=2 SAVR+CABG, and n=2 aortic surgeries). After matching, 8 patients in the CVP group were compared with 16 patients in the matched cohort. Comparable rates of reperfusion were achieved. Time from symptom onset to groin puncture (171.5 min (136.3, 178.3) vs 284.0 min (215.0, 490.5); p=0.039), as well as recanalization (195.0 min (146.0, 201.0) vs 419.0 min (274.0, 613.0); p=0.028) was faster in the CVP group. However, this was not reflected by an improved outcome (modified Rankin Scale score after 90 days: 5.5 (3.3, 6.0) vs 5.0 (4.0, 6.0), mortality after 90 days 50.0% vs 37.5%). Complications did not differ between the groups.ConclusionsUse of MT for LVO stroke in patients after a recent CVP is a safe and efficient treatment in comparison with patients with a non-periprocedural LVO undergoing MT.

Endovascular thrombectomy: an effective and safe therapy for perioperative ischemic stroke

“…Consistent with previous studies 10 11 24 28 , EVT did not lead to an increase in total intracranial hemorrhage in perioperative AIS patients compared to community-onset AIS patients. However, when hemorrhages with different subtypes according to the Heidelberg hemorrhage classification were considered, there were significantly more perioperative AIS patients with HI1 and PH1 type hemorrhages and subarachnoid hemorrhage than community-onset AIS patients.…”

“…Our study showed that the recanalization rate after EVT did not differ between perioperative and community-onset AIS stroke patients, which corroborates previous studies on stroke patients after both cardiovascular and non-cardiovascular surgeries 10 24 . Importantly, the time from symptom onset to groin puncture in our study is shorter in perioperative stroke patients than in community-onset AIS stroke patients (median time, 239 vs. 433 minutes).…”

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

“…We found that higher NIHSS scores were associated with open cardiac surgery, which is consistent with previously published estimates of the NIHSS score after open cardiac surgery (presumably due to higher rates of large-vessel occlusion and comorbid anesthesia or sedation) . We also found that cardiac intervention was associated with lower probability of having an NIHSS score documented.…”