Acute Ischemic Stroke in the Cardiothoracic Surgery Patient: Thrombolytic Therapy or Mechanical Thrombectomy?
Purpose: To review and outline evidence-based guidance of acute ischemic stroke (AIS) in post-operative cardiac surgery patients.
Background: Stroke is a devastating complication after cardiac surgery and accounts for substantially high post-surgical mortality and morbidity. Peri-surgical stroke leads to longer hospital stay and increased economic burden in the management of post cardiovascular surgery patients. Management of AIS in patients with recent cardiac surgery is challenging and needs careful consideration of both, risks and benefits of different interventions. Addressing the risk factors and timely secondary prevention for neurologic complications is crucial in improving outcomes post cardiac surgery.
Method: Evidence-based review of management of stroke post cardiac surgery and important steps of secondary prevention post cardiac surgery are depicted in this chapter. This chapter illustrates recommendations on difficult decisions in managing stroke in post cardiac surgery patients using GRADE classification.
Conclusion: Intravenous t-PA (tissue plasminogen activator) is contraindicated in treatment of stroke in patients post cardiothoracic surgery. Available options include intra-arterial t-PA and mechanical thrombectomy. Interventional procedures have emerged as a promising option for management of stroke post cardiac surgery. Timely detection of neurological complications is challenging but crucial to improve outcomes in patients post cardiac surgery. Medical management of AIS post cardiac surgery presents several challenging questions reviewed in this chapter along with gaps which need to be addressed in the future.
KeywordsCardiothoracic surgery Acute ischemic stroke Mechanical thrombectomy Contraindication to t-PA Secondary prevention of stroke Mechanical thrombectomy and outcomes
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