Tong Xin, Xue Xiaopeng, Wen Zhuohua, Duan Chuanzhi, Feng Xin, Huo Xiaochuan
Cerebrovascular Disease Department, Neurological Disease Center Beijing Anzhen Hospital, Capital Medical University Beijing China.
Laboratory for Clinical Medicine Capital Medical University Beijing China.
J Am Heart Assoc. 2025 May 6;14(9):e040531. doi: 10.1161/JAHA.124.040531. Epub 2025 May 2.
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.
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%, =0.043), more routine discharge (23.5% versus 15.8%, =0.002), but higher proportion of intracranial hemorrhage (21.50% versus 12.50%, <0.001) and similar rate of evacuation of intracranial hemorrhage (3.30% versus 1.60%, =0.084) compared with non-EVT after CS. In Analysis-2, no statistical differences were found between EVT after CS and EVT without CS.
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.
关于心脏手术后急性缺血性卒中患者血管内血栓切除术（EVT）的疗效证据有限。因此，我们旨在评估因心脏手术导致的急性缺血性卒中患者接受EVT的疗效。
回顾性研究数据取自2016年至2020年的国家再入院数据库。将心脏手术后7天内接受EVT的急性缺血性卒中患者与两组进行比较：心脏手术后未接受EVT的患者（分析1）和未进行心脏手术而接受EVT的患者（分析2）。主要结局是由出院处置决定的功能结局。采用倾向评分匹配以尽量减少协变量不平衡，并按心脏手术类型进行亚组分析。在整个队列中，983例患者在心脏手术后接受了EVT治疗，43578例患者在心脏手术后接受了非EVT治疗，66829例患者未进行心脏手术而接受了EVT治疗。在分析1匹配后的结局中，心脏手术后接受EVT治疗的患者功能结局不良的比例较低（57.6%对63.7%，P = 0.043），常规出院的比例更高（23.5%对15.8%，P = 0.002），但与心脏手术后非EVT治疗相比，颅内出血的比例更高（21.50%对12.50%，P<0.001），颅内出血清除率相似（3.30%对1.60%，P = 0.084）。在分析2中，心脏手术后接受EVT与未进行心脏手术接受EVT之间未发现统计学差异。
短期功能结局的良好结果表明，EVT可能是心脏手术后急性缺血性卒中患者一种有效且可接受的治疗方式。然而，这些患者颅内出血的风险仍然令人担忧。
