Very Early Carotid Endarterectomy After Intravenous Thrombolysis

• Published in: European journal of vascular and endovascular surgery Vol. 51; no. 4; pp. 482 - 486
• Main Authors: Azzini, C, Gentile, M, De Vito, A, Traina, L, Sette, E, Fainardi, E, Mascoli, F, Casetta, I
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2016
• Subjects: Adult; Aged; Aged, 80 and over; Carotid endarterectomy; Carotid Stenosis - complications; Carotid Stenosis - diagnosis; Carotid Stenosis - mortality; Carotid Stenosis - surgery; Databases, Factual; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - mortality; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Humans; Infusions, Intravenous; Intravenous thrombolysis; Ischaemic stroke; Male; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Recurrence; Retrospective Studies; Risk Factors; Severity of Illness Index; Stroke - diagnosis; Stroke - drug therapy; Stroke - etiology; Stroke - mortality; Surgery; Thrombolytic Therapy - adverse effects; Thrombolytic Therapy - mortality; Time Factors; Time-to-Treatment; Treatment Outcome; Intravenous thrombolysis; Ischaemic stroke; Carotid endarterectomy
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2015.11.006

Objective/Background The timing of carotid endarterectomy (CEA) after thrombolysis is still a matter of debate. The aim of this study was to analyse a cohort of patients undergoing urgent endarterectomy after intravenous thrombolysis for acute ischaemic stroke. Methods This was an observational study. Prospective databases were reviewed and matched to identify patients who underwent CEA early after intravenous thrombolysis (2009–14). The focus was carotid surgery performed within 12 hours of stroke onset in patients with a high grade (≥70%) symptomatic carotid stenosis, associated with vulnerable plaques or stroke in evolution, and evidence of a significant salvageable ischaemic penumbra on perfusion computed tomography scan. Demographic and clinical information, as well as data on relevant outcomes were extracted. Results Thirty four consecutive stroke patients who underwent CEA within 2 weeks of thrombolysis for acute ischaemic stroke and ipsilateral high grade carotid stenosis were identified. In 11 patients the surgical procedure was performed within 12 hours of the onset of symptoms. All patients showed a clinical improvement after combined treatment. The 3 month outcome was favourable (modified Rankin Scale ≤ 2) in 10 patients. No haemorrhagic complications were registered. There was neither peri-operative stroke nor stroke within 3 months of surgery. One patient died from acute myocardial infarction 3 days after intervention. Conclusion This experience suggests that very early CEA after thrombolysis, aimed at removing the source of potential embolisation and restoring blood flow, may be safe and can lead to a favourable outcome.