Despite significant advancements in stroke treatments in recent years, resulting in improved outcomes for many individuals, there remains a group of patients who do not benefit from these effective therapies: those who experience strokes following heart surgery.
Research conducted at Yale School of Medicine indicates that patients who undergo heart surgery are significantly less likely to receive potentially life-saving and disability-preventing treatments compared to those who have not had cardiac procedures.
Endovascular thrombectomy, the most effective treatment for ischemic strokes, involves navigating a thin catheter through an artery from the wrist or groin to clear blockages in the brain’s arteries. However, this treatment must be administered within the first 24 hours of symptom onset, preferably sooner.
Detecting strokes promptly in patients who have undergone heart surgery can be challenging for various reasons. Additionally, these patients are generally ineligible for another major treatment option for ischemic stroke, intravenous thrombolysis with tissue plasminogen activator (tPA), due to its blood-thinning effects.
To investigate the disparity in receiving post-operative endovascular treatment among stroke patients who have undergone heart surgery, Dr. Adam de Havenon, a vascular neurologist and associate professor of neurology at Yale School of Medicine, and his team analyzed a national database encompassing stroke patient data from nearly 5,000 hospitals spanning the years 2016 to 2020.
Their analysis revealed that patients experiencing ischemic strokes within three days post-cardiac procedure were less than half as likely to receive endovascular stroke treatment compared to those whose strokes were not associated with cardiac interventions.
Cardiac surgeries, such as valve repair or stent implantation, pose a significant risk of stroke by potentially causing blood clots that may travel to the brain or damaging the arteries responsible for transporting blood from the heart to the brain. This risk places cardiac surgery as the second-highest procedure associated with post-surgical stroke, following only brain surgery. Furthermore, cardiac implants like pacemakers or stents can further elevate the risk of stroke post-surgery.
Dr. de Havenon, the lead researcher, emphasized the concerning finding that even as of 2020, the most effective treatment for ischemic stroke was not routinely offered to individuals following cardiac surgery, highlighting a substantial gap in care.
Utilizing the comprehensive National Inpatient Sample database, which captures data from inpatients across numerous U.S. hospitals, the researchers examined information from over 630,000 stroke patients, including more than 12,000 individuals who had undergone cardiac procedures.
Furthermore, their analysis indicated that patients who did receive endovascular treatment following heart surgery were more than twice as likely to be discharged home compared to those who did not receive the therapy, underscoring the efficacy of the treatment. Patients unable to return home often required rehabilitation or long-term care, or unfortunately, did not survive.
Addressing the treatment inequity in this patient population presents challenges, primarily due to the myriad complications that cardiac surgery patients may experience before and after their procedures, particularly in cases of open-heart surgery, which can obscure stroke symptoms.
Dr. de Havenon proposed the potential use of continuous neural monitoring to detect strokes early in this population. By monitoring brain activity or blood flow to the brain, healthcare teams could identify stroke indicators even in sedated patients. This vigilant monitoring, coupled with training to swiftly recognize and address stroke symptoms, could facilitate timely treatment for these patients.
In addition to evaluating the impact of brain monitoring on increasing endovascular treatment utilization, Dr. de Havenon aims to assess patient outcomes post-therapy through a pilot study. The researchers also intend to investigate which cardiac procedures are most closely linked to strokes to identify patients who could benefit the most from enhanced stroke monitoring.
Dr. de Havenon emphasized the potential for improvement in stroke care within the context of cardiac interventions, underscoring the need for enhanced monitoring and treatment strategies.
More information:
Adam de Havenon et al, Endovascular Treatment of Acute Ischemic Stroke After Cardiac Interventions in the United States, JAMA Neurology (2024).
Citation:
Study highlights disparities in life-saving treatment for stroke after heart surgery (2024, February 19)
retrieved 19 February 2024 from Medical Xpress.
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