Safety and efficacy of intraarterial thrombolysis for perioperative strokeafter cardiac operation

Background. Acute ischemic stroke after cardiac operations is a devastating complication with limited therapeutic options. As clinical trials of throm bolysis for acute ischemic stroke exclude patients with recent major surger y, the safety of intraarterial thrombolysis in this setting is unknown. Methods. Thirteen patients with acute ischemic stroke within 12 days of car diac operation underwent intraarterial thrombolysis within 6 hours of strok e 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, coron ary 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. Recanali zation 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 car diac operation, intraarterial thrombolysis appears to be reasonably safe an d may lead to neurologic recovery. (C) 2001 by The Society of Thoracic Surg eons.