Mechanical Thrombectomy Improves Outcome for Large Vessel Occlusion Stroke after Cardiac Surgery
Copyright © 2021 Elsevier Inc. All rights reserved..
BACKGROUND: Stroke is a feared complication of cardiac surgery. Modern clot-retrieval techniques provide effective treatment for large vessel occlusion (LVO) strokes. The purpose of this study was to 1) report the incidence of LVO stroke after cardiac surgery at a large academic center, and 2) describe outcomes of postoperative LVO strokes.
METHODS: All patients experiencing stroke within 30 days after undergoing cardiac surgery at a single center in 2014-2018 were reviewed. LVOs were identified through review of imaging and medical records, and their characteristics and clinical courses were examined.
RESULTS: Over the study period, 7,112 cardiac surgeries, including endovascular procedures, were performed. Acute ischemic stroke within 30 days after surgery was noted in 163 patients (2.3%). Among those with a stroke, 51/163 (31.3%) had a CTA or MRA, and 15/163 (9.2%) presented with LVO stroke. For all stroke patients, the median time from surgery to stroke was 2 days (interquartile range, IQR, 0-6 days), and for patients with LVO, the median time from surgery to stroke was 4 days (IQR 0-6 days). The overall rate of postoperative LVO was 0.2% (95% CI 0.1-0.4%), though only 6/15 received thrombectomy. LVO patients receiving thrombectomy were significantly more likely to return to independent living compared to those managed medically (n = 4/6, 66.6% for mechanical thrombectomy vs. n = 0/9, 0% for medical management, P = .01). Of the 9 patients who did not get thrombectomy, 6 may currently be candidates for thrombectomy given new expanded treatment windows.
CONCLUSIONS: The rate of LVO after cardiac surgery is low, though substantially elevated above the general population, and the majority do not receive thrombectomy currently. Patients receiving thrombectomy had improved neurologic outcomes compared to patients managed medically. Optimized postoperative care may increase the rate of LVO recognition, and cardiac surgery patients and their caregivers should be aware of this effective therapy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association - 30(2021), 8 vom: 15. Aug., Seite 105851 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wilkinson, D Andrew [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiac surgery |
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| Anmerkungen: |
Date Completed 27.07.2021 Date Revised 27.07.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jstrokecerebrovasdis.2021.105851 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM325696659 |
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| 100 | 1 | |a Wilkinson, D Andrew |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Mechanical Thrombectomy Improves Outcome for Large Vessel Occlusion Stroke after Cardiac Surgery |
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| 500 | |a Date Completed 27.07.2021 | ||
| 500 | |a Date Revised 27.07.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Stroke is a feared complication of cardiac surgery. Modern clot-retrieval techniques provide effective treatment for large vessel occlusion (LVO) strokes. The purpose of this study was to 1) report the incidence of LVO stroke after cardiac surgery at a large academic center, and 2) describe outcomes of postoperative LVO strokes | ||
| 520 | |a METHODS: All patients experiencing stroke within 30 days after undergoing cardiac surgery at a single center in 2014-2018 were reviewed. LVOs were identified through review of imaging and medical records, and their characteristics and clinical courses were examined | ||
| 520 | |a RESULTS: Over the study period, 7,112 cardiac surgeries, including endovascular procedures, were performed. Acute ischemic stroke within 30 days after surgery was noted in 163 patients (2.3%). Among those with a stroke, 51/163 (31.3%) had a CTA or MRA, and 15/163 (9.2%) presented with LVO stroke. For all stroke patients, the median time from surgery to stroke was 2 days (interquartile range, IQR, 0-6 days), and for patients with LVO, the median time from surgery to stroke was 4 days (IQR 0-6 days). The overall rate of postoperative LVO was 0.2% (95% CI 0.1-0.4%), though only 6/15 received thrombectomy. LVO patients receiving thrombectomy were significantly more likely to return to independent living compared to those managed medically (n = 4/6, 66.6% for mechanical thrombectomy vs. n = 0/9, 0% for medical management, P = .01). Of the 9 patients who did not get thrombectomy, 6 may currently be candidates for thrombectomy given new expanded treatment windows | ||
| 520 | |a CONCLUSIONS: The rate of LVO after cardiac surgery is low, though substantially elevated above the general population, and the majority do not receive thrombectomy currently. Patients receiving thrombectomy had improved neurologic outcomes compared to patients managed medically. Optimized postoperative care may increase the rate of LVO recognition, and cardiac surgery patients and their caregivers should be aware of this effective therapy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiac surgery | |
| 650 | 4 | |a Complications | |
| 650 | 4 | |a Large vessel occlusion | |
| 650 | 4 | |a Outcomes | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Thrombectomy | |
| 700 | 1 | |a Koduri, Sravanthi |e verfasserin |4 aut | |
| 700 | 1 | |a Anand, Sharath Kumar |e verfasserin |4 aut | |
| 700 | 1 | |a Daou, Badih J |e verfasserin |4 aut | |
| 700 | 1 | |a Sood, Vikram |e verfasserin |4 aut | |
| 700 | 1 | |a Chaudhary, Neeraj |e verfasserin |4 aut | |
| 700 | 1 | |a Gemmete, Joseph J |e verfasserin |4 aut | |
| 700 | 1 | |a Burke, James F |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Himanshu J |e verfasserin |4 aut | |
| 700 | 1 | |a Pandey, Aditya S |e verfasserin |4 aut | |
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