Frontiers in neurology · 2026
Mechanical thrombectomy for acute ischemic stroke after cardiac surgery or intervention: a retrospective cohort analysis.
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Eckert Rosa M, Zweynert Sarah, Czimmeck Constanze, Schoels Maximilian, Bohner Georg, Siebert Eberhard, Hrytsyna Yuriy, Potapov Evgenij, Falk Volkmar, Ploner Christoph J, Brandes Jörg, Leithner Christoph
Аннотация
BACKGROUND: Acute stroke due to large vessel occlusion (LVO) is a serious complication of cardiac surgery or other cardiac interventions. Little is known about the epidemiological characteristics of affected patients, the temporal relationship between stroke detection and surgery/intervention, the efficacy of mechanical thrombectomy, or the associated clinical outcomes.
METHODS: We retrospectively analyzed the demographic and thrombectomy characteristics and neurological outcomes of patients who underwent mechanical thrombectomy for acute ischemic stroke due to LVO after cardiac surgery/intervention in a large academic heart center.
RESULTS: From January 2018 to January 2022, a total of 39 patients underwent thrombectomy for acute ischemic stroke with LVO following cardiac surgery/intervention. The median age was 66 years (IQR 57.5-76.0), and 13 patients (33.3%) were female. The highest frequency of thrombectomy for LVO-related stroke was observed after left ventricular assist device (LVAD) surgery (1.9%), followed by coronary artery bypass grafting (CABG) (0.20%), transcatheter aortic valve replacement (0.14%), and heart catheterization (0.04%). Stroke symptoms were detected in a wake-up constellation in 20 of the 39 patients (51.3%). Successful recanalization (TICI 2b/3) was achieved in 83.8% of patients. At three months, 21.2% of patients attained a good functional outcome (modified Rankin scale score 0-2).
CONCLUSIONS: Thrombectomy for LVO stroke was conducted in a small subset of patients after cardiac surgery/intervention. A large proportion of these strokes were detected in a wake-up constellation. Early detection, optimized acute neurological workup, and rapid thrombectomy may result in good functional outcomes. The establishment of a standardized diagnostic and treatment algorithm seems advisable for the optimization of acute stroke treatment in large heart centers.
METHODS: We retrospectively analyzed the demographic and thrombectomy characteristics and neurological outcomes of patients who underwent mechanical thrombectomy for acute ischemic stroke due to LVO after cardiac surgery/intervention in a large academic heart center.
RESULTS: From January 2018 to January 2022, a total of 39 patients underwent thrombectomy for acute ischemic stroke with LVO following cardiac surgery/intervention. The median age was 66 years (IQR 57.5-76.0), and 13 patients (33.3%) were female. The highest frequency of thrombectomy for LVO-related stroke was observed after left ventricular assist device (LVAD) surgery (1.9%), followed by coronary artery bypass grafting (CABG) (0.20%), transcatheter aortic valve replacement (0.14%), and heart catheterization (0.04%). Stroke symptoms were detected in a wake-up constellation in 20 of the 39 patients (51.3%). Successful recanalization (TICI 2b/3) was achieved in 83.8% of patients. At three months, 21.2% of patients attained a good functional outcome (modified Rankin scale score 0-2).
CONCLUSIONS: Thrombectomy for LVO stroke was conducted in a small subset of patients after cardiac surgery/intervention. A large proportion of these strokes were detected in a wake-up constellation. Early detection, optimized acute neurological workup, and rapid thrombectomy may result in good functional outcomes. The establishment of a standardized diagnostic and treatment algorithm seems advisable for the optimization of acute stroke treatment in large heart centers.