Safety and efficacy of intraarterial thrombolysis for perioperative stroke after cardiac operation.
BACKGROUND
Acute ischemic stroke after cardiac operations is a devastating complication with limited therapeutic options. As clinical trials of thrombolysis for acute ischemic stroke exclude patients with recent major surgery, the safety of intraarterial thrombolysis in this setting is unknown.


METHODS
Thirteen patients with acute ischemic stroke within 12 days of cardiac operation underwent intraarterial thrombolysis within 6 hours of stroke symptom onset. The National Institutes of Health Stroke Scale was used to assess neurologic recovery.


RESULTS
The mean age was 69 years (standard deviation +/-5 years) and 62% were men. Cardiac procedures included valve operations in 6 patients, coronary artery bypass grafting in 4, valve and coronary artery bypass grafting in 2, and left ventricular assist device in 1 patient. Atrial fibrillation occurred in 5 patients (38%). The mean time from operation to stroke was 4.3 days (standard deviation +/- 3 days). Thrombolysis was initiated within 3.6 hours (standard deviation +/-1.6 hours) of stroke symptom onset. Recanalization was complete in 1 patient, partial in 5, and 7 patients had low flow. Neurologic improvement occurred in 5 patients (38%). One patient needed a chest tube for hemothorax, 2 others were transfused for low hemoglobin. No operative intervention for bleeding was necessary.


CONCLUSIONS
In select patients with acute ischemic stroke after recent cardiac operation, intraarterial thrombolysis appears to be reasonably safe and may lead to neurologic recovery.
Moazami
N
N
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
Smedira
N G
NG
McCarthy
P M
PM
Katzan
I
I
Sila
C A
CA
Lytle
B W
BW
Cosgrove
D M
DM
D000368:Aged; D002544:Cerebral Infarction / Q000188:drug therapy*; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006353:Heart-Assist Devices; D006801:Humans; D020766:Intracranial Embolism / Q000188:drug therapy*; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator