Introduction: Acute ischemic stroke (AIS) complicating cardiac interventions (CI) is well described. The use of mechanical thrombectomy (MT) for treatment of acute ischemic stroke (AIS) in this setting, however, is not widely reported, particularly in the stent-retriever era.

Methods: Cases of patients undergoing MT for AIS at a single neurovascular institution were reviewed. Cases preceded by recent CI were investigated retrospectively. Data was collected for patient demographics, type of cardiac intervention, stroke characteristics, neurovascular intervention, and patient outcomes.

Results: Between 2008 and 2017, registry analysis identified nine patients treated with MT for AIS complicating recent CI. Patients were largely male (78%) with a mean age of 67 years. A large majority had a known cardiac arrhythmia (67%). Coronary artery bypass graft surgery (CABG) was the most commonly identified CI (44%), followed by valve repair (22%), and cardiac ablations (22%). A majority of patients developed AIS three to five days after the CI (56%). Mean presenting NIHSS was 18. 67% of cases presented with moderate to severe (NIHSS 16-20) or severe (NIHSS 21-42) symptoms at onset. Most presented with hemiplegia (89%). Only one patient received intravenous thrombolytics. Seven cases were found to have MCA occlusions with the remaining cases involving AIS of the basilar circulation. Stent-retrievers were used in 67% of cases with excellent rates of recanalization in five MCA cases (TICI 2c or 3) and in one basilar case. Despite immediate improvements in NIHSS scores in most cases (78%), functional outcomes were poor in 78% of cases (mRS of 4-6). Three cases were complicated by hemorrhage and two of these three ended in mortality.

Conclusions: AIS following recent CI is associated with high rates of mortality and poor functional outcomes despite MT. Further work is needed to understand the key drivers to poor outcomes in this difficult subgroup.

Patient Care: Patients suffering from acute ischemic stroke complicating cardiac interventions are generally excluded from receiving intravenous tPA and have historically had poor outcomes with high rates of mortality. Much of the existing literature for intra-arterial therapies for this subgroup come from before the stent-retriever era. This early research will encourage investigation into the impact of modern endovascular therapies for these patients and allow identification of drivers of morbidity.

Learning Objectives: 1. Cardiac interventions can be complicated by acute ischemic stroke 2. Mechanical thrombectomy in AIS following CI is not well described 3. Functional outcomes are poor in AIS following CI despite MT

References: 1. Anyanwu AC, Filsoufi F, Salzberg SP, Bronster DJ, Adams DH: Epidemiology of stroke after cardiac surgery in the current era. The Journal of Thoracic and Cardiovascular Surgery 134:1121–1127.e1, 2007 2. Madeira M, Martins C, Koukoulis G, Marques M, Reis J, Abecassis M: Mechanical Thrombectomy for Stroke After Cardiac Surgery: MECHANICAL THROMBECTOMY FOR STROKE. Journal of Cardiac Surgery 31:517–520, 2016 3. Salinas P, Moreno R, Frutos R, Lopez-Sendon JL: Neurovascular Rescue for Thrombus-Related Embolic Stroke During Transcatheter Aortic Valve Implantation. JACC: Cardiovascular Interventions 6:981–982, 2013