To analyze the clinical presentation of ischemic strokes after cardiovascular surgeries, its severity and characteristics after isolated Coronary Artery Bypass Grafting (CABG) vs other kind of cardiovascular surgeries (CS) including combined CABG.

Ischemic stroke is an under-reported complication after cardiovascular surgeries, with an incidence up to 5% in some series, depending predominantly on the type of procedure.

Retrospective study of patients suffering from an ischemic stroke up to 30 days post-cardiovascular surgery, between January 2016 and December 2018. Demographic variables, vascular risk factors, procedures’ characteristics, time to symptoms´ onset, NIHSS and treatments were analyzed. CABG-patients and CS-patients were compared.

During a 3-year period, 35 ischemic strokes were found out of 1862 cardiovascular surgeries. No hemorrhagic strokes were registered. Mean age was 66.6 years (SD 11.9), 40% female. Incidence after CABG was 1.11 (N=7/627), and after CS 2.26 (N=28/1235) (p=0.10).

When comparing demographic variables and risk factors, in CABG-patients, a history of symptomatic coronary artery disease was common; without significant differences for the rest of risk factors. Procedure duration, use and length of extracorporeal circulation, time to symptoms´ onset, NIHSS and mortality didn´t show statistical differences.

As all patients had rtPA thrombolysis contraindications, six were evaluated for endovascular treatment. In the CABG group, one patient underwent mechanical thrombectomy while the rest didn´t show a large vessel occlusion. Time elapsed until recognition of stroke symptoms was the commonest of exclusion criteria for mechanical thrombectomy.

Ischemic stroke after cardiovascular surgery is uncommon, but with an important impact in morbidity and mortality. In our study, post-CABG and post-CS stroke didn´t show significant differences in frequency, severity and mortality.

New treatment options prompt physicians to search for early symptoms recognition in postoperative patients in order to detect potential thrombectomy candidates.