[Consensus paper on peri-interventional and postinterventional stroke during cardiac catheter procedures]

Area of Science:

• Cardiology
• Neurology
• Interventional Medicine

Background:

• Stroke is a significant complication following percutaneous coronary intervention (PCI) and atrial fibrillation ablation.
• Patients undergoing these procedures face a high risk of persistent neurological deficits post-stroke.
• Existing antithrombotic and anticoagulation therapies often contraindicate standard thrombolysis, complicating treatment decisions.

Framework:

• Optimal conditions for recanalization therapy arise due to vessel occlusion occurring within the catheter suite or chest pain unit.
• Mandatory elements include prompt brain imaging and a collaborative interdisciplinary approach.
• Intracerebral vessel occlusion necessitates intra-arterial thrombolysis, potentially combined with mechanical clot fragmentation, as the primary treatment.

Implementation:

• Treatment decisions are individualized, considering stroke severity.
• Pre-existing antithrombotic and anticoagulation drug regimens are critical factors in therapeutic planning.
• The availability of neuro-interventionalists and the local team's expertise influence the chosen management strategy.

Implications:

• Effective management strategies are vital to mitigate neurological deficits after cardiac interventions.
• Tailored therapeutic decisions improve patient outcomes in stroke complicating PCI and ablation.
• Advancements in neuro-interventional techniques offer new hope for managing these complex cases.