By Matthew Fink, MD
Cardiac surgery is associated with a high rate of ischemic stroke as a complication. This problem is more common in cases of open-heart surgery. The stroke rate is estimated at between 1% and 2% of individuals undergoing cardiac surgery. There are little data regarding the frequency with which endovascular thrombectomy (EVT) is performed for treatment of acute ischemic stroke associated with cardiac surgery, even though this is likely to be caused by cardiogenic embolism and large artery occlusion.
Recent cardiac surgery is a strong contraindication to having intravenous thrombolysis for ischemic stroke. Endovascular thrombectomy, if appropriate, would be the best treatment for these patients. To obtain additional understanding of the prevalence of ischemic stroke and treatment with EVT following cardiac surgery, these investigators queried a large claims-based database.
This was a retrospective analysis of a cohort from data acquired from 4,888 U.S. hospitals from 2016-2020 as part of the National Inpatient Sample database. All patients older than 18 years of age with an ischemic stroke diagnosis were organized into groups of hospitalized patients with cardiac interventions vs. those without. Individuals were excluded from the study if they had a procedure prior to hospital admission or had EVT performed for other reasons prior to or three days after the cardiac surgery.
Data were acquired from 634,407 hospitalizations, comprising 318,363 male patients and 316,044 female patients. Cardiac interventions were performed in a total of 12,093 patients. The National Institutes of Health Stroke Scale (NIHSS) score was reported for approximately one-third of the admissions without cardiac interventions and 21% of those with cardiac interventions. EVT was performed in 3.8% of patients without cardiac interventions vs. 1.6% of those with cardiac interventions (P < 0.001).
EVT was less likely to be performed in stroke patients who had cardiac surgery vs. those without, with an odds ratio of 0.27. This difference remained after adjusting for the NIHSS score. Patients who were treated with endovascular thrombectomy for stroke associated with cardiac surgery had a twofold higher chance of being discharged to home. Although these data are not informative regarding the reasons for lower rates of EVT for these patients, further investigation should be undertaken to understand the reasons and, one hopes, improve outcomes with more aggressive treatment.
