Postcardiac Surgery Acute Stroke Therapies: A Systematic Review

Area of Science:

• Neurology
• Cardiovascular Surgery
• Interventional Neuroradiology

Background:

• Acute ischemic stroke is a serious complication following cardiac surgery.
• Effective treatment strategies for post-cardiac surgery stroke are crucial for patient outcomes.

Purpose of the Study:

• To identify and evaluate interventions for acute ischemic stroke occurring after cardiac surgery.
• To report the efficacy of treatments such as intra-arterial thrombolysis (IAT) and endovascular mechanical thrombectomy (EMT).

Main Methods:

• Systematic review and narrative synthesis of relevant literature.
• Searched MEDLINE, Embase, Scopus, and Cochrane databases (1990-2018).
• Included 8 case reports/series and 2 retrospective studies (n=33).

Main Results:

• Intra-arterial thrombolysis (IAT) in 19 patients showed 16% good, 42% moderate, and 42% poor neurologic outcomes.
• Endovascular mechanical thrombectomy (EMT) in 14 patients resulted in 50% good, 36% moderate, and 14% poor neurologic outcomes.
• EMT, with or without IAT, is increasingly used for post-cardiac surgery stroke.

Conclusions:

• Endovascular thrombectomy is emerging as a successful treatment for stroke post-cardiac surgery.
• Current evidence is based on a small number of patients, limiting definitive conclusions on overall efficacy.
• Further research is needed to establish the definitive impact of these interventions on neurologic outcomes.