Safety and efficacy of thrombolytic therapy in postoperative cerebral infarctions

Acute ischemic stroke is a common and devastating complication of many surgical procedures. If diagnosed early, however, there are reasonably safe and effective treatment options. Although IV rtPA is the most well studied means of recanalization after ischemic stroke, it should be avoided within 14 days of a surgical procedure in favor of other locally directed techniques that carry a significantly lower risk of bleeding at the surgical site. Only in rare circumstances, when these newer modalities are not available and the surgery is minor, should IV rtPA be considered in postoperative patients. The treatment of choice for carefully selected patients with postoperative strokes is IAT with either rtPA or urokinase. IAT may be attempted up to 6 hours after an acute ischemic stroke and may be assisted by mechanical clot disruption/embolectomy in an attempt to improve recanalization rates. In patients who have had a recent craniotomy or any surgery where surgical site bleeding is expected to be massive or difficult to control or where small amounts of bleeding could be life threatening, IAT should be avoided. In these patients, and in patients who present greater than 6 hours but less than 8 hours after their stroke, mechanical thrombolysis/embolectomy may emerge as the only viable treatment option.