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E-027 Mechanical Thrombectomy for Acute Ischemic Stroke in Post-surgical Patients
  1. M Litao1,
  2. H Bhamra1,
  3. K DeSousa2,
  4. E Raz2,
  5. E Nossek3,
  6. A Favate1,
  7. M Shapiro4,
  8. T Becske5,
  9. P Nelson2
  1. 1Neurology, New York University, New York, NY
  2. 2Radiology, New York University, New York, NY
  3. 3Neurosurgery, Maimonides Medical Center, New York, NY
  4. 4Neurology/Radiology, New York University, New York, NY
  5. 5Neurology, Rochester Regional Health, Rochester, NY

Abstract

Introduction Ischemic strokes in the post-surgical period may negatively impact clinical outcome. Major surgery within the previous 14 days is a relative contraindication to intravenous-tPA administration. Mechanical thrombectomy may thus become a valid treatment option. We present our experience in a series of patients who presented with a clinical stroke syndrome in the post-surgical period who underwent emergent angiography with intent to treat.

Methods This is a retrospective review of patients who were treated from January 2012 to March 2015 in our institution. Patients who had emergent angiography after presenting with clinical stroke during the post-surgical period were included. Type of surgery, clinical characteristics, imaging studies, treatment variables, and discharge modified Rankin scores were collected.

Results 15 patients had emergent angiography in the post-surgical period. The mean age is 68.87 years. 87% (13/15) had cardiovascular surgery, 8 (62%) of which were valvular repairs. 57% (8/14) presented in the immediate post-surgical period. The mean NIHSS was 18. Mean symptom duration from time last known well was 256 minutes. 10/11 (91%) had perfusion deficits on CTP.

60% (9/15) had proximal vessel occlusion while 33% (5/15) had distal occlusions, and 1 had no occlusion. Of the 9 patients with proximal vessel occlusions, 7 underwent thrombectomy with the Solitaire device achieving a 57% (4/7) TICI 2 b/3 recanalization rate. The mean mRS for all patients in the series is 3.79. Patients with TICI 2 b/3 recanalization did significantly better at discharge than those who did not, mean mRS of 1.67 vs. 5, p = 0.019.

Conclusion In our experience, emergent angiography among post-surgical stroke patients showed proximal vessel occlusion in more than half of patients, making them potential candidates for mechanical thrombectomy. Those who achieved TICI 2 b/3 recanalization performed clinically better than those who did not. This may indicate the potential benefit of mechanical thrombectomy among post-surgical stroke patients. The overall lower recanalization rates in this cohort may reflect atypical clot characteristics encountered in post-surgical patients and would be an interesting avenue for further investigation.

Disclosures M. Litao: None. H. Bhamra: None. K. DeSousa: None. E. Raz: None. E. Nossek: None. A. Favate: None. M. Shapiro: 2; C; Covidien. T. Becske: 2; C; Covidien. P. Nelson: 2; C; Covidien.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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