A Systematic Review and Meta-analysis of Peri-Procedural Outcomes in Patients Undergoing Carotid Interventions Following Thrombolysis

Kakkos, Stavros K.; Céniga, Melina Vega de; Naylor, Ross

doi:10.1016/j.ejvs.2021.06.003

Cited by 12 publications

(7 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent meta-regression has suggested that CEA within 3 days of IVT caused a 13% perioperative risk of stroke and death, and 6.8 days had to pass for the perioperative risk of CEA to reach < 6%. 9 Our data suggest that the risk of recurrent ipsilateral ischemic stroke before CEA/CAS is 10% at day 3 and 12% at day 7 in IVTtreated patients. Whether waiting with CEA until day 7 in IVTtreated patients is preferable to treatment at day 3 remains unclear, as a randomized approach would be preferable method to assess this to an error-prone direct numerical comparison of our three merged cohorts and the meta-regression.…”

Section: Discussionmentioning

confidence: 54%

“…8 Also, IVT treatment possibly increases the risk of perioperative stroke/death with CEA or stenting (CAS) performed within 7 days of IVT treatment. 9 Therefore, to enable assessment of optimal timing of CEA/CAS in IVT-treated patients, additional assessments of preoperative risk of stroke in IVT-treated patients were called for in recent guidelines. 10…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk of Stroke Recurrence After Intravenous Thrombolysis in Patients with Symptomatic Carotid Stenosis

Nordanstig,

Gu,

Henze

et al. 2023

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

Objective: To assess if intravenous thrombolysis (IVT) affects the risk of recurrent preoperative cerebrovascular events before carotid surgery or stenting in patients with symptomatic ≥ 50% carotid stenosis. Methods: Three cohorts of symptomatic ≥ 50% carotid stenosis patients were merged. To make the control group relevant, we excluded patients not presenting with stroke on the day of symptom onset. The risk of preoperative cerebrovascular events up to 30 days was compared between the IVT-treated and non-IVT-treated. Results: In total, 316 patients were included, 64 (20%) treated with IVT. Those treated with IVT had similar risk of recurrent ipsilateral ischemic stroke or retinal artery occlusion (12% at day 7, 12% at day 30) as those not treated (9% at day 7, 15% at day 30; adjusted HR 0.9, 95% CI 0.4–2.2). There was a tendency (p = 0.09) towards time-dependency in the data where the recurrence risk was higher in IVT-treated at day 0 (6% in IVT-treated, 1% in non-IVT-treated, OR 5.5, 95% CI 1.2–25.4, p = 0.03). This was not significant when adjusting for co-factors (adjusted OR 4.4, 95% CI 0.9–21.8, p = 0.07) and was offset by a later risk decrease, with no remaining risk difference between IVT-treated and non-IVT-treated at day 7. Conclusions: Intravenous thrombolysis treatment does not seem to affect the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic ≥50% carotid stenosis: The risk is high in both IVT-treated and non-IVT-treated. However, there might be a risk increase on the day of IVT treatment that is offset by a risk decrease during the first week.

show abstract

Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Risk of Stroke Recurrence After Intravenous Thrombolysis in Patients with Symptomatic Carotid Stenosis

Nordanstig,

Gu,

Henze

et al. 2023

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

show abstract

“…21,22 A recently published systematic review and meta-analysis of outcome after CEA following thrombolysis, found an increased risk of stroke/death if CEA was performed early after thrombolysis. 9 In total, 54% of the EVT patients in the present study had intravenous thrombolysis before thrombectomy, but the rate of thrombolysis decreased during the study period; from 61% in 2011e2017, to 49% in 2018e2020, as a consequence of changed indications for EVT.…”

Section: Discussionmentioning

confidence: 59%

Carotid Endarterectomy After Intracranial Endovascular Thrombectomy for Acute Ischaemic Stroke in Patients with Carotid Artery Stenosis

Jonsson

Aro

Björses

et al. 2022

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

“… For patients who have received intravenous thrombolysis for acute ischaemic stroke with 50–90% carotid stenosis, CAS should only be considered six days post-thrombolysis to minimise post-interventional haemorrhage. For patients facing neurological instability (defined as those who have suffered a disabling stroke with a modified Rankin score > 3, or altered consciousness/drowsiness,) and 50–99% carotid stenosis, the recommendation is to postpone CAS (or CEA) until there is evidence of neurological improvement [ 8 , 19 , 20 ]. …”

Section: Patient Preparationmentioning

confidence: 99%

“…For patients facing neurological instability (defined as those who have suffered a disabling stroke with a modified Rankin score > 3, or altered consciousness/drowsiness,) and 50–99% carotid stenosis, the recommendation is to postpone CAS (or CEA) until there is evidence of neurological improvement [ 8 , 19 , 20 ].…”

Section: Patient Preparationmentioning

confidence: 99%

CIRSE Standards of Practice on Carotid Artery Stenting

Spiliopoulos,

Blanc,

Gandini

et al. 2024

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

Background Carotid artery stenting has been used effectively to treat internal carotid artery stenosis since 1989 (Mathias et al. in World J Surg. 25(3):328-34, 2001), with refined and expanded techniques and tools presently delivering outstanding results in percutaneous endoluminal treatment of carotid artery stenosis. Purpose This CIRSE Standards of Practice document is directed at interventional radiologists and details the guidelines for carotid artery stenting, as well as the different implementation techniques. In addition to updating all previously published material on the different clinical indications, it will provide all technical details reflective of European practice for carotid artery stenting. CIRSE Standards of Practice documents do not aim to implement a standard of clinical patient care, but rather to provide a realistic strategy and best practices for the execution of this procedure. Methods The writing group, which was established by the CIRSE Standards of Practice Committee, consisted of five clinicians with internationally recognised expertise in carotid artery stenting procedures. The writing group reviewed existing literature on carotid artery stenting procedures, performing a pragmatic evidence search using PubMed to select relevant publications in the English language from 2006 to 2022. Results Carotid artery stenting has an established role in the management of internal carotid artery stenosis; this Standards of Practice document provides up-to-date recommendations for its safe performance.

show abstract

A Systematic Review and Meta-analysis of Peri-Procedural Outcomes in Patients Undergoing Carotid Interventions Following Thrombolysis

Cited by 12 publications

References 34 publications

Risk of Stroke Recurrence After Intravenous Thrombolysis in Patients with Symptomatic Carotid Stenosis

Risk of Stroke Recurrence After Intravenous Thrombolysis in Patients with Symptomatic Carotid Stenosis

Carotid Endarterectomy After Intracranial Endovascular Thrombectomy for Acute Ischaemic Stroke in Patients with Carotid Artery Stenosis

CIRSE Standards of Practice on Carotid Artery Stenting

Contact Info

Product

Resources

About