Safety and Efficacy of Endovascular Thrombectomy for Acute Ischemic Stroke After Cardiac Surgery: A Retrospective Analysis of Readmission Nationwide Database Data

J Am Heart Assoc. 2025 May 6;14(9):e040531. doi: 10.1161/JAHA.124.040531. Epub 2025 May 2.

ABSTRACT

BACKGROUND: There is limited evidence regarding outcomes of endovascular thrombectomy (EVT) in patients with acute ischemic stroke after cardiac surgery (CS). Therefore, we aimed to evaluate the outcomes of EVT in patients with acute ischemic stroke attributable to CS.

METHODS AND RESULTS: The data of retrospective study was obtained from the National Readmission Database between 2016 and 2020. Patients with acute ischemic stroke who received EVT within 7 days after CS were compared with 2 groups: those who did not receive EVT after CS (Analysis-1) and those who received EVT without CS (Analysis-2). The primary outcome was functional outcome determined by discharge disposition. Propensity score matching was employed to minimize covariate imbalance and subgroup analyses were conducted by type of CS. In the total cohort, 983 patients received EVT treatment after CS, 43 578 patients had non-EVT treatment after CS, and 66 829 patients received EVT treatment without CS. In the Analysis-1 outcomes after matching, the EVT treatment after CS had a lower poor functional outcome (57.6% versus 63.7%, P=0.043), more routine discharge (23.5% versus 15.8%, P=0.002), but higher proportion of intracranial hemorrhage (21.50% versus 12.50%, P<0.001) and similar rate of evacuation of intracranial hemorrhage (3.30% versus 1.60%, P=0.084) compared with non-EVT after CS. In Analysis-2, no statistical differences were found between EVT after CS and EVT without CS.

CONCLUSIONS: Favorable findings of short-term functional outcomes demonstrate that EVT is likely an effective and acceptable treatment modality for patients with acute ischemic stroke following CS. However, the risk of intracranial hemorrhage remains a concern in these patients.

PMID:40314362 | DOI:10.1161/JAHA.124.040531