Mechanical Thrombectomy for Acute Ischemic Stroke After Cardiac Surgery or Intervention: A Retrospective Cohort Analysis

Rosa Marie Eckert^1*Sarah Zweynert¹Constanze Czimmeck¹Maximilian Schoels^1,2Georg Bohner³Eberhard Siebert³Yuriy Hrytsyna⁴Evgenij Potapov^4,5Volkmar Falk^4,5,6Christoph J. Ploner¹Jörg Brandes⁴Christoph Leithner^1*

• ¹Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
• ²Berlin Institute of Health at Charite, Berlin, Germany
• ³Institute of Neuroradiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
• ⁴Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany
• ⁵DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
• ⁶Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland

Abstract Background Acute stroke due to large vessel occlusion (LVO) is a serious complication of cardiac surgery or other cardiac interventions. Little is known about the epidemiological characteristics of affected patients, the temporal relationship between stroke detection and surgery/intervention, the efficacy of mechanical thrombectomy, or the associated clinical outcomes. Methods We retrospectively analyzed the demographic and thrombectomy characteristics and neurological outcomes of patients who underwent mechanical thrombectomy for acute ischemic stroke due to LVO after cardiac surgery/intervention in a large academic heart center. Results From January 2018 to January 2022, a total of 39 patients underwent thrombectomy for acute ischemic stroke with LVO following cardiac surgery/intervention. The median age was 66 years (IQR 57.5–76.0), and 13 patients (33.3%) were female. The highest frequency of thrombectomy for LVO-related stroke was observed after left ventricular assist device (LVAD) surgery (1.9%), followed by coronary artery bypass grafting (CABG) (0.20%), transcatheter aortic valve replacement (0.14%), and heart catheterization (0.04%). Stroke symptoms were detected in a wake-up constellation in 20 of the 39 patients (51.3%). Successful recanalization (TICI 2b/3) was achieved in 83.8% of patients. At three months, 21.2% of patients attained a good functional outcome (modified Rankin scale score 0–2). Conclusions Thrombectomy for LVO stroke was conducted in a small subset of patients after cardiac surgery/intervention. A large proportion of these strokes were detected in a wake-up constellation. Early detection, optimized acute neurological workup, and rapid thrombectomy may result in good functional outcomes. The establishment of a standardized diagnostic and treatment algorithm seems advisable for the optimization of acute stroke treatment in large heart centers.