Cargando…

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

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. ME...

Descripción completa

Detalles Bibliográficos
Autores principales: Gupta, Aashray K., Sabab, Ahad, Goh, Rudy, Ovenden, Christopher D., Kovoor, Joshua G., Ramponi, Fabio, Chan, Justin C. Y., Reddi, Benjamin A. J., Bennetts, Jayme S., Maddern, Guy J., Kleinig, Timothy J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10100038/
https://www.ncbi.nlm.nih.gov/pubmed/36335602
http://dx.doi.org/10.1111/jocs.17082
_version_ 1785025189791137792
author Gupta, Aashray K.
Sabab, Ahad
Goh, Rudy
Ovenden, Christopher D.
Kovoor, Joshua G.
Ramponi, Fabio
Chan, Justin C. Y.
Reddi, Benjamin A. J.
Bennetts, Jayme S.
Maddern, Guy J.
Kleinig, Timothy J.
author_facet Gupta, Aashray K.
Sabab, Ahad
Goh, Rudy
Ovenden, Christopher D.
Kovoor, Joshua G.
Ramponi, Fabio
Chan, Justin C. Y.
Reddi, Benjamin A. J.
Bennetts, Jayme S.
Maddern, Guy J.
Kleinig, Timothy J.
author_sort Gupta, Aashray K.
collection PubMed
description 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.
format Online
Article
Text
id pubmed-10100038
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-101000382023-04-14 Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery Gupta, Aashray K. Sabab, Ahad Goh, Rudy Ovenden, Christopher D. Kovoor, Joshua G. Ramponi, Fabio Chan, Justin C. Y. Reddi, Benjamin A. J. Bennetts, Jayme S. Maddern, Guy J. Kleinig, Timothy J. J Card Surg Regular Issue Papers 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. John Wiley and Sons Inc. 2022-11-06 2022-12 /pmc/articles/PMC10100038/ /pubmed/36335602 http://dx.doi.org/10.1111/jocs.17082 Text en © 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Regular Issue Papers
Gupta, Aashray K.
Sabab, Ahad
Goh, Rudy
Ovenden, Christopher D.
Kovoor, Joshua G.
Ramponi, Fabio
Chan, Justin C. Y.
Reddi, Benjamin A. J.
Bennetts, Jayme S.
Maddern, Guy J.
Kleinig, Timothy J.
Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
title Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
title_full Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
title_fullStr Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
title_full_unstemmed Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
title_short Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
title_sort endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
topic Regular Issue Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10100038/
https://www.ncbi.nlm.nih.gov/pubmed/36335602
http://dx.doi.org/10.1111/jocs.17082
work_keys_str_mv AT guptaaashrayk endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT sababahad endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT gohrudy endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT ovendenchristopherd endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT kovoorjoshuag endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT ramponifabio endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT chanjustincy endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT reddibenjaminaj endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT bennettsjaymes endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT maddernguyj endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery
AT kleinigtimothyj endovascularthrombectomyforlargevesselocclusionacuteischemicstrokeaftercardiacsurgery