Safety of Early Carotid Endarterectomy after Intravenous Thrombolysis in Acute Ischemic Stroke
Language English Country Netherlands Media print-electronic
Document type Comparative Study, Journal Article
PubMed
28479465
DOI
10.1016/j.avsg.2017.03.195
PII: S0890-5096(16)31148-7
Knihovny.cz E-resources
- MeSH
- Time-to-Treatment * MeSH
- Time Factors MeSH
- Stroke diagnosis drug therapy etiology mortality MeSH
- Fibrinolytic Agents administration & dosage adverse effects MeSH
- Administration, Intravenous MeSH
- Brain Ischemia diagnosis drug therapy etiology mortality MeSH
- Endarterectomy, Carotid * adverse effects mortality MeSH
- Middle Aged MeSH
- Humans MeSH
- Carotid Artery Diseases complications diagnostic imaging mortality surgery MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Thrombolytic Therapy * adverse effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
- Names of Substances
- Fibrinolytic Agents MeSH
BACKGROUND: The timing of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) is still a controversial issue. The aim of this study was to assess the safety of early carotid interventions in patients treated with thrombolysis for acute ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data from consecutive patients who underwent CEA for symptomatic internal carotid artery stenosis within 14 days after the index neurological event during the period from January 2013 to July 2016. Patients who had undergone IVT before CEA were identified. The primary outcome measures were any stroke and death rate at 30 days, symptomatic intracerebral hemorrhage and surgical site bleeding requiring intervention. RESULTS: A total of 93 patients were included for the final analysis. Among these, 13 (14.0%) patients had undergone IVT before CEA while 80 (86.0%) patients had CEA only. The median time interval between IVT and CEA was 2 days (range: 0-13). A subgroup of 6 patients underwent CEA within 24 hours of administration of IVT. The 30-day combined stroke and death rate was 7.7% (1 of 13) among patients undergoing IVT before CEA and 5.0% (4 of 80) among those undergoing CEA only (P = 0.690). In the IVT group, there were no cerebral hemorrhages or significant surgical site bleeding events requiring reintervention. CONCLUSIONS: Our experience indicates that CEA performed early after IVT for acute ischemic stroke, aiming not only to reduce the risk of stroke recurrence but also to achieve neurological improvement by reperfusion of the ischemic penumbra, may be safe and can lead to favorable outcomes.
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