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Nader Moazami
Nicholas G. Smedira
Patrick M. McCarthy
Bruce W. Lytle
Delos M. Cosgrove, III
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Ann Thorac Surg 2001;72:1933-1938
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Safety and efficacy of intraarterial thrombolysis for perioperative stroke after cardiac operation

Nader Moazami, MDa, Nicholas G. Smedira, MD*a, Patrick M. McCarthy, MDa, Irene Katzan, MDb, Cathy A. Sila, MDb, Bruce W. Lytle, MDa, Delos M. Cosgrove, III, MDa

a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

* Address reprint requests to Dr Smedira, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195, USA
e-mail: smedirn{at}ccf.org

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

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.


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Invited commentary
Victor G. Davila-Roman and Charles W. Hogue, Jr
Ann. Thorac. Surg. 2001 72: 1938-1939. [Extract] [Full Text] [PDF]



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