Stroke patients post-surgery are less likely to receive life-saving treatments

Acute ischemic stroke treatment post-cardiac interventions.

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A Yale School of Medicine study found that patients with stroke after heart surgery are likely to receive fewer life-saving treatments. This research was published in JAMA Neurology.

Endovascular thrombectomy is the best treatment for the most common type of stroke, ischemic stroke. It clears blockages in the brain’s arteries but must be done within 24 hours of symptoms. Detecting strokes quickly after heart surgery is challenging. Surgery patients can’t get another standard stroke treatment, tPA, due to blood thinning.

Dr. Adam de Havenon and his team at Yale studied stroke data from 5,000 hospitals from 2016 to 2020. They found that patients who had strokes after heart surgery were much less likely to get endovascular treatment within three days compared to those who didn’t have heart surgery.

Cardiac surgery, like valve repair or stent implantation, can increase the risk of stroke by causing blood clots or damaging arteries leading to the brain. It’s the second-highest risk surgery for stroke. Even cardiac implants like pacemakers can raise this risk. Dr. de Havenon led a study finding that stroke patients after cardiac surgery often don’t get the best stroke treatment available.

De Havenon, who led the study, said, “The data show that even up to 2020, we were not offering the single most effective treatment for ischemic stroke that we have to individuals after cardiac surgery. There’s a major disparity here.”

They used an extensive database from U.S. hospitals, analyzing over 630,000 stroke patients, including 12,000 who had cardiac procedures. Patients who did receive the best treatment were more likely to go home after, showing how effective it is. Others went to rehab or long-term care or sadly didn’t survive.

Addressing the treatment gap for these patients is challenging. Cardiac surgery patients often have many complications before and after their procedures, especially with open-heart surgery, making stroke symptoms harder to spot.

Sedation and ventilation after surgery can mask stroke symptoms like movement or speech problems. Early endovascular treatment could help, but it’s difficult once symptoms appear later. These cases are challenging for doctors.

Addressing the treatment gap for these patients is challenging. Cardiac surgery patients often have many complications before and after their procedures, especially with open-heart surgery, making stroke symptoms harder to spot.

Sedation and ventilation after surgery can mask stroke symptoms like movement or speech problems. Early endovascular treatment could help, but it’s difficult once symptoms appear later. These cases are challenging for doctors.

The research shows that stroke patients who’ve had heart surgery are less likely to get life-saving treatments. More studies are needed to determine why this happens and how to fix it. It’s essential to have better monitoring for strokes and quick treatment for people having heart procedures.

Journal reference:

  1. Adam de Havenon, Lily W. Zhou et al., Endovascular Treatment of Acute Ischemic Stroke After Cardiac Interventions in the United States. JAMA Neurology. DOI: 10.1001/jamaneurol.2023.5416.
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