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Updated: Jun 4, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular therapy for cardiac catheterization associated strokes
Aitziber Aleu1, Muhammad Vbv S Hussain, Ridwan Lin
1Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Insights
Endovascular therapy for stroke after cardiac catheterization is safe and feasible, showing better outcomes than expected despite high mortality. Faster treatment implementation is crucial for these acute stroke patients.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Stroke is a significant complication of cardiac catheterization.
- Endovascular therapy is effective for large-vessel occlusion strokes.
- Limited data exists on endovascular treatment for cardiac catheterization-associated strokes.
Purpose of the Study:
- To evaluate the safety and clinical outcomes of endovascular therapy for acute strokes occurring during or after cardiac catheterization.
Main Methods:
- Retrospective analysis of endovascular stroke treatment databases from two university hospitals (2006-2008).
- Identified 14 cases of stroke associated with cardiac catheterization from 419 interventions.
- Collected data on patient demographics, stroke severity, treatment times, and outcomes.
Main Results:
- 14 patients (3.34%) experienced stroke post-cardiac catheterization; mean age 71, 57.1% female.
- Mean NIH Stroke Scale was 17; median time to treatment was 240 minutes.
- 50% had a favorable outcome (mRS ≤ 2), with 42% in-patient mortality.
Conclusions:
- Multimodal endovascular therapy is safe and feasible for cardiac catheterization-associated strokes.
- Outcomes were more favorable than natural history, despite high mortality.
- Treatment delays were observed; faster recanalization therapy implementation is needed.
Background:
Stroke is one of the most feared complications after cardiac catheterization. Endovascular treatment combining mechanical and pharmacological therapy has been reported as an effective treatment option in selected patients with acute stroke due to large-vessel occlusion. Little is known about safety and clinical outcome when this approach is utilized in cardiac catheterization associated strokes.
Methods And Results:
We analyzed clinical and radiological characteristics and outcomes in the endovascular acute stroke treatment databases from two University Hospitals from July 2006 to December 2008 (Cleveland Clinic Foundation) and September 1999 and December 2008 (UPMC Presbyterian hospital), respectively. Of a total of 419 acute stroke interventions, 14 (3.34%) were identified as strokes during or immediately after cardiac catheterization. The mean age was 71 ± 7 years; eight were women (57.1%). Mean National Institute of Health Stroke Scale was 17 (±7.6). Four patients underwent intravenous thrombolysis followed by intraarterial intervention. Median time to treatment was 240 minutes from last time seen normal (range 66-1,365 minutes). Seven patients (50%) had a favorable outcome (modified Rankin Scale [mRS]≤ 2). In-patient mortality was 42%.
Conclusion:
In acute strokes following cardiac catheterization, multimodal endovascular therapy is safe and feasible and despite a high mortality is associated with a higher than expected rate of favorable outcomes compared to the natural history of the disease. Despite a significant proportion of patients developing symptoms in hospitals where neurointerventions are available, the median time to treatment was longer than expected. Future efforts should focus on faster implementation of recanalization therapies for this form of acute stroke.
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