625 © Springer Nature Switzerland AG 2019 V. A. Lonchyna (ed.), Diffcult Decisions in Cardiothoracic Critical Care Surgery, Diffcult Decisions in Surgery: An Evidence-Based Approach, https://doi.org/10.1007/978-3-030-04146-5_42 Chapter 42 Acute Ischemic Stroke in the Cardiothoracic Surgery Patient: Thrombolytic Therapy or Mechanical Thrombectomy? Masoom Desai and Deborah M. Stein Introduction Stroke is a devastating complication after cardiac surgery and accounts for substan- tially higher post-surgical mortality and morbidity. Peri-operative mortality for patients who suffer a stroke post cardiac surgery is considerably higher than those who do not (32.8% vs. 4.9%) [1]. Stroke post cardiac surgery has signifcant economic consequences with pro- longed length of stays in the hospital incurring estimated costs that exceed two to four billion annually worldwide for patients with stroke after CABG [2]. Post- operative stroke signifcantly increases the number of patients being discharged to long term facilities post cardiac surgery. In addition, there are detrimental effects on quality of life in these patients. The incidence of stroke post cardiac surgery varies with the risk profle of the patients and the defnition of stroke used in different studies. Estimated frequencies are much higher when the radiographic or clinically silent infarcts are included in the defnition of stroke. The incidence of peri-operative stroke after cardiac surgery has been reported to be between 0.8% and 9.8% [1]. The incidence of peri-operative stroke varies with the type of the procedure as illustrated in Table 42.1 [3, 4]. In addition, the incidence is higher after an urgent surgery compared to elective sur- gery. The timing of the stroke has been varyingly reported in the literature as well. M. Desai (*) McGaw Medical Center, Division of Epilepsy and Neurophysiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA e-mail: masoom.desai@northwestern.edu D. M. Stein R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA e-mail: dstein@umm.edu