Page 66 - BH-3-1

Brain & Heart Thrombectomy for stroke after cardiac surgery

among similar studies reported in the literature, and the of mismatch cerebral blood flow and Tmax would indicate
study confirms the efficacy of thrombectomy to a certain that treatment is unlikely to benefit the patient. Tmax >6s
extent. 1,15-20 Detailed information is presented in Table 2. is considered a low perfusion area, while cerebral blood
Patients who underwent thrombectomy were evaluated flow <30% relative to the contralateral side is considered
using multimodal CT, which is central to AIS diagnosis the infarct core. The subtraction of the two areas is the
and treatment. Non-contrast CT imaging is beneficial for penumbra. This key information provided by CTP can help
21
24
the selection of patients for all acute stroke therapies. In screen the population that will benefit from MT treatment.
addition to ruling out intracranial hemorrhage, the extent Uncomplicated cardiac surgery, such as CABG, has a
of early ischemic injury can also be estimated. CTA can be post-operative cerebral infarction risk of 1 – 3%, but for
used to evaluate extracranial and intracranial vessels, as some complex surgeries, such as multi-valve replacement
well as collateral grading. Extracranial CTA can provide and aortic arch repair, the probability can be increased to
information about potential proximal embolic sources, 5 – 10%. 25-27 Chen et al. summarized the significant risk
2
such as atherosclerotic lesions, arterial dissection, and factors for post-operative stroke as follows: advanced
thrombi from the aortic arch. Furthermore, intracranial age, female sex, peripheral disease, previous stroke, and
CTA can confirm the diagnosis of AIS. CTA can also help atrial fibrillation. Sheriff et al. found that prolonged
19
qualitatively assess the patient’s collateral circulation, aortic cross-clamp time (odds ratio [OR]: 1.012 for every
which is an indicator closely related to prognosis. CTP minute of prolonged aortic cross-clamp time; confidence
22
maps qualitatively demonstrate the core infarction and interval [CI]: 1.001 – 1.023) and cardiac bypass time (OR:
salvageable penumbra area. This useful tool has been used in 1.012 for every minute of prolonged cardiac bypass time;
both late-window MT trials and was incorporated into the CI: 1.003 – 1.021) are associated with LVO stroke. In our
recent guidelines. Based on the metrics of CTP, an absence series, three patients had new-onset AF after surgery and
23

Table 2. Characteristics of similar works from literature about patients who underwent thrombectomy following cardiac surgery
Author, publication Country Male Included Recruitment Surgery eTICI 2b50 and Good
year (%) patients period above (%) outcome (%)
Feng et al. (this article) China 5 (55.6) 9 July 2023 to Valve surgery: 4 7 (77.8) 6 (66.7)
June 2024 CABG: 4
Morrow: 1
Bay et al., 2023 18 Germany 5 (45.5) 11 June 2015 to CABG: 3 7 (63.6) 2 (18.2)
December CABG with valve surgery: 2
2020 Valve surgery: 4
Aortic arch surgery: 2
Gupta et al., 2022 15 Australia 5 (71.4) 7 January 2016– CABG: 2 4 (57.1) 3 (42.9)
October 2021 Valve surgery: 4
CABG with valve surgery: 1

Wilkinson et al., 2021 16 America 4 (66.7) 6 2014 to 2017 CABG: 3 NA 4 (66.7)
Valve surgery with arch replacement: 1
Maze surgery: 1
Maze with valve surgery: 1
Sheriff et al., 2019 19 America NA 3 July 2013 to Left ventricular assist device placement: 1 2 (66.7) 2 (66.7)
April 2018 Valve surgery with arch repair: 1
Valve surgery with maze procedure: 1
Haider et al., 2017 17 America 1 (50) 2 NA CABG: 1 2 (100) 2 (100)
Left ventricular assist device implantation:
1
Thomas et al., 2017 20 America 0 1 NA Valve surgery 1 (100) 1 (100)
Madeira et al., 2016 1 Portugal 0 3 NA CABG: 1 3 (100) 2 (66.7)
Blalock–Taussig shunt and atrial
septostomy: 1
Supracoronary aorta interposition
grafting: 1
Note: A good outcome is defined as a patient with a mRS score of 0 – 2 at 90 days or in the last follow-up.
Abbreviations: CABG: Coronary artery bypass grafting; mRS: Modified Rankin Scale; NA: Not available.

Volume 3 Issue 1 (2025) 6 doi: 10.36922/bh.4141