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Updated: Aug 23, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery
Aashray K Gupta1, Ahad Sabab1, Rudy Goh2
1Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia.
Insights
Endovascular thrombectomy (EVT) offers a life-saving intervention for acute ischemic stroke (AIS) following cardiac surgery. This study found EVT associated with excellent outcomes in this patient population, highlighting the importance of postoperative neurological monitoring.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Acute ischemic stroke (AIS) is a serious complication after cardiac surgery.
- Previously, effective treatments for post-cardiac surgery AIS were limited.
- Endovascular thrombectomy (EVT) presents a potentially life-saving intervention.
Purpose of the Study:
- To examine the outcomes of EVT in patients who developed AIS after cardiac surgery.
- To report the largest case series to date of EVT in this specific patient group.
Main Methods:
- Retrospective review of a stroke database (January 2016 - October 2021).
- Identification of patients who underwent EVT for AIS post-cardiac surgery.
- Assessment of demographic data, operation types, stroke severity, imaging, management, and outcomes (mortality, modified Rankin Score).
Main Results:
- Seven patients (0.8%) received EVT following cardiac surgery, with varied procedures.
- Median NIHSS score was 26, indicating severe strokes.
- All patients survived, with a median 3-month modified Rankin Score of 3.
Conclusions:
- EVT can be associated with excellent outcomes in patients experiencing AIS after cardiac surgery.
- This study represents the largest case series of EVT in this population.
- Close postoperative neurological monitoring is crucial for identifying eligible patients.
Introduction:
Acute ischemic stroke (AIS) can be a catastrophic complication of cardiac surgery previously without effective treatment. Endovascular thrombectomy (EVT) is a potentially life-saving intervention. We examined patients at our institution who had EVT to treat AIS post cardiac surgery.
Methods:
We retrospectively reviewed a stroke database from January 1, 2016 to October 31, 2021 to identify patients who had undergone EVT to treat AIS following cardiac surgery. Demographic data, operation type, stroke severity, imaging features, management and outcomes (mortality and modified Rankin Score (mRS)) were assessed.
Results:
Of 5022 consecutive patients with AIS, 870 underwent EVT. Seven patients (0.8%) had EVT following cardiac surgery. Operations varied: two coronary artery bypass grafting (CABG), two transcatheter AVR, one redo surgical aortic valve replacement (AVR), one mitral valve repair and one patient with combined aortic and mitral valve replacements and CABG. Meantime postsurgery to stroke symptoms onset was 3 days (range 0-9 days). Median NIHSS was 26 (range 10-32). Five patients had middle cerebral artery occlusion and two internal carotid artery (n = 2). Median time between onset of symptoms and recanalization was 157 min (range 97-263). Two patients received Intra-arterial Thrombolysis. All patients survived and were discharged to another hospital (n = 3), home (n = 2), or rehabilitation facility (n = 2). Median 3-month mRS was 3 (range 0-6).
Conclusion:
We report the largest case series of EVT after cardiac surgery. EVT can be associated with excellent outcomes in these patients. Close neurological monitoring postoperatively to identify patients who may benefit from intervention is key.
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