Multimodal computed tomography-guided mechanical thrombectomy for large vessel occlusion stroke after cardiac surgery

Abstract

Post-operative large vessel occlusion (LVO) stroke is one of the most severe complications associated with cardiac surgery. Mechanical thrombectomy (MT) is the first-line treatment for LVO stroke. In this paper, we present cases of patients who underwent MT guided by multimodal computed tomography (CT) to treat LVO stroke after cardiac surgery at our institution to clarify the impact of MT on patient outcomes. We analyzed the in-hospital stroke database from July 1, 2023, to June 30, 2024, to identify patients who had undergone MT to treat LVO stroke after cardiac surgery in our institution. Demographic data, stroke severity, type of operation, imaging features, and 90-day modified Rankin scale (mRS) scores were assessed. Of the 21 patients receiving endovascular therapy, we included nine (42.9%) who had undergone multimodal CT-guided MT after cardiac surgery. The operations varied and comprised four coronary artery bypass grafts, four surgical valve replacements, and one extended Morrow myectomy. The median time from post-surgery to the onset of stroke symptoms was 4 days (interquartile range [IQR]: 2.5 - 5 days), the median National Institutes of Health Stroke Scale score was 16 (IQR: 15 - 18), and the median time between the onset of symptoms and recanalization was 320 min (IQR: 270 - 465 min). One patient died of severe cerebral hemorrhage, while eight patients survived and were discharged to another hospital (n = 1), a rehabilitation facility (n = 3), or home (n = 4). The median 3‐month mRS was 2 (IQR: 0.5 - 3). In summary, multimodal CT-guided MT can improve the prognosis of patients with LVO stroke, although severe neurological deficits and mortality were observed in some patients. A larger sample size is required to clarify the effects of MT.

Keywords

Cardiac surgery / Large vessel occlusion / Acute ischemic stroke / Mechanical thrombectomy / Multimodal CT

Acknowledgments

None.

Funding

This work was supported by the National High-Level Hospital Clinical Research Funding (2022-GSP-TS-4).

Conflict of interest

Shujuan Li is an Editorial Board Member of this journal butwas not in any way involved in the editorial and peer-reviewprocess conducted for this paper, directly or indirectly.Separately, other authors declared that they have no knowncompeting financial interests or personal relationships thatcould have influenced the work reported in this paper.

Author contributions

Conceptualization: Shujuan Li, Yao Feng

Formal analysis: Yao Feng, Guitao Zhang

Investigation: Guitao Zhang, Bin Lv

Methodology: Na Zhao, Bincheng Wang

Writing - original draft: Yao Feng, Bincheng Wang

Writing - review & editing: Shujuan Li, Bin Lv

Ethics approval and consent to participate

The Research Ethics Committee of Fuwai Hospital, ChineseAcademy of Medical Sciences, approved this study (Ethicsapproval code: 2022-1848). Data were collected retrospectively,and no further procedure was performed; hence, therequirement to obtain informed consent was waived.

Consent for publication

All images used in this study were anonymized; hence, the requirement to obtain consent for publication was waived.

Availability of data

The data used in this study will be made available from the corresponding authors upon request.

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