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CLINICAL RESEARCH: INVASIVE CARDIOLOGY

The Safety and Efficacy of Thrombolysis for Strokes After Cardiac Catheterization

Pooja Khatri, MD^_*,_*, Robert A. Taylor, MD, Vanessa Palumbo, MD, Venkatakrishna Rajajee, MD, Jeffrey M. Katz, MD^||, Julio A. Chalela, MD^¶, Ann Geers, RN^_*, Joseph Haymore, MS, ACNP^#, Daniel M. Kolansky, MD^_**, Scott E. Kasner, MD for the Treatment of Acute Stroke after Cardiac Catheterization (TASCC) Study Group

^_* Department of Neurology, University of Cincinnati, Cincinnati, Ohio
Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, Minnesota
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
Critical Care and Neurology, Sundaram Medical Foundation, Chennai, India
^|| Departments of Neurology and Radiology, North Shore University Hospital, Bronx, New York
^¶ Departments of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
^# Georgetown University School of Nursing & Health Studies, Washington, DC
^_** Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.

Manuscript received May 29, 2007; revised manuscript received August 14, 2007, accepted September 23, 2007.

^_* Reprint requests and correspondence: Dr. Pooja Khatri, University of Cincinnati Academic Health Center, Department of Neurology, 260 Stetson Street, Suite 2300, P.O. Box 670525, Cincinnati, Ohio 45267-0525. (Email: pooja.khatri{at}uc.edu).

Objectives: The purpose of this study was to systematically compare clinical outcomes of patients treated with thrombolysis with those without treatment in a multi-year, multicenter cohort of strokes after cardiac catheterization.

Background: Ischemic strokes after cardiac catheterization procedures, although uncommon, lead to the morbidity and mortality of thousands of patients each year. Despite the availability of Food and Drug Administration–approved thrombolytic therapy for acute ischemic stroke since 1996, thrombolysis remains unestablished in the setting of cardiac catheterization, owing to unique concerns regarding safety and efficacy.

Methods: Consecutive cases of ischemic stroke after cardiac catheterization were abstracted retrospectively and reviewed by clinicians at 7 major North American academic centers with acute stroke teams. Safety and efficacy outcome measures were pre-defined.

Results: A total of 66 cases of ischemic strokes after cardiac catheterization were identified over 3 to 4 years; 12 (18%) were treated with thrombolysis, consisting of 7 intravenous and 5 intra-arterial recombinant tissue plasminogen activator cases. Improvement in stroke symptoms, as measured by the primary efficacy measure of median change in National Institutes of Health Stroke Scale score from baseline to 24 h, was greater in treated versus nontreated cases (p < 0.001). Additional secondary measures of efficacy also showed better outcomes in the treated group. There were no significant differences in bleeding events, defined as symptomatic intracerebral hemorrhage, hemopericardium, or other systemic bleeding resulting in hemodynamic instability or blood tranfusions. Mortality rates were also similar.

Conclusions: Thrombolysis might improve early outcomes after post-catheterization strokes and seems safe in this context. Emergent cerebral revascularization should be a routine consideration.

Abbreviations and Acronyms   CT = computed tomography   ICH = intracerebral hemorrhage   NIHSS = National Institutes of Health Stroke Scale   rt-PA = recombinant tissue plasminogen activator   SCC = stroke after cardiac catheterization

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