Safety of Early Carotid Endarterectomy after Intravenous Thrombolysis in Acute Ischemic Stroke

Guňka, I; Krajíčková, Dagmar; Leško, Michal; Renc, Ondřej; Raupach, Jan; Jiška, Stanislav; Lojík, Miroslav; Chovanec, Vendelı́n; Malý, Radován

doi:10.1016/j.avsg.2017.03.195

Cited by 12 publications

(9 citation statements)

References 35 publications

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“…12 However, recent case series including patients operated within 24 to 72 hours after CEA found a small and insignificant increase in 30-day complication rate in IVT group when compared with non-IVT group. 13,14 Reason behind the slightly increased complication rate of CEA performed within the first 48 hours after cerebrovascular symptoms is not fully elucidated; it is not known whether it is because of excess in bleeding complications as a result from hyperperfusion syndrome or embolic events from unstable carotid plaque. Furthermore, none of the earlier studies have taken into account the recurrent stroke rates during the waiting time for CEA, most probably because the data deriving from national registers often miss detailed clinical data on that time period.…”

Section: Strokementioning

confidence: 99%

Prior Intravenous Stroke Thrombolysis Does Not Increase Complications of Carotid Endarterectomy

Ijäs

Aro

Eriksson

et al. 2018

Stroke

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Background and Purpose- Carotid endarterectomy (CEA) is recommended within 14 days after carotid artery stroke to prevent recurrence. However, the optimal timing of CEA after intravenous thrombolysis (IVT) remains unclear. We studied the safety of CEA after IVT while taking into account both stroke recurrence and CEA-related complications. Methods- Patients who underwent IVT followed by CEA in Helsinki University Hospital 2005 to 2016 were withdrawn from prospectively collected registers. The incidence of stroke recurrence during the time between IVT and CEA, peri/postoperative stroke, hyperperfusion syndrome or drug-resistant high blood pressure, and 3-month outcome measured by modified Rankin Scale was recorded. Stroke patients treated with CEA without preceding IVT were used as controls. Results- Altogether 128 CEAs with preceding IVT and 777 CEAs for stroke without IVT were identified. The median time from IVT to CEA was 9 days (range, 0-349 days; interquartile range, 16). Seven patients (5.5%) underwent CEA within 24 hours, 20 (15.6%) within 48 hours and 87 (68.0%) within 2 weeks from IVT. Stroke recurrence in IVT-CEA patients was 5.5% at median 4 days after IVT (range, 0-8 days). Outcome from CEAs performed within 48 hours from IVT did not differ from CEAs performed later with respect to peri/postoperative ischemic strokes (5.0% and 3.7%), hemorrhagic strokes (5.0% and 1.9%), neck hematomas (5.0% and 8.3%), myocardial infarctions (0.0% and 0.9%), or 3-month modified Rankin Scale. There was a tendency toward higher incidence of hyperperfusion syndrome in the patients operated within 48 hours from IVT (20.0% versus 6.5%; P=0.070). The CEA-related stroke rate was similar to that of the operation without thrombolysis. Only smoking was significantly associated with peri/postoperative stroke (odds ratio, 21.82; 95% confidence interval, 1.08-439.58). Conclusions- Time between IVT and CEA was not associated with CEA-related complications. The high rate of stroke recurrence during the waiting time for CEA underscores the importance of shortening surgery delays.

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Section: Strokementioning

confidence: 99%

Prior Intravenous Stroke Thrombolysis Does Not Increase Complications of Carotid Endarterectomy

Ijäs

Aro

Eriksson

et al. 2018

Stroke

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“…[6,9]. В связи с этим появляются работы, в которых оцениваются результаты «ранних» операций на сонных артериях после ТЛТ, при этом спорными и до конца нерешенными остаются вопросы относительно эффективности, безопасности и целесообразности этого комбинированного метода лечения [14,15].…”

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“…Отсутствие однозначных рекомендаций по эффективности и безопасности выполнения «ранних» операций на каротидном бассейне обусловлены тем, что существующие рекомендательные документы по выполнению каротидной эндартерэктомии (КЭЭ) или стентирования ВСА основаны на результатах оперативных вмешательств без предшествующего тромболизиса. Работ, посвященных комбинированному лечению (тромболизис+КЭЭ или стентирование ВСА), крайне мало, результаты их разнятся, а сроки выполнения операции после проведенного тромболизиса до конца не определены [14,15].…”

unclassified

“…Внутричерепные кровоизлияния после КЭЭ, выполненных в острой стадии инсульта после тромболизиса, диагностируются в 0-14% случаев, при этом основным фактором риска развития внутримозговой гематомы является артериальная гипертензия с кризовым течением на фоне гиперперфузионного синдрома [15,17,20]. По мнению A. Naylor [21], ключевым моментом в решении этой проблемы должно быть агрессивное лечение интра-и послеоперационной артериальной гипертензии.…”

unclassified

“…В литературе [15,17] имеются также сравнительные работы, посвященные сопоставлению результатов операций на сонных артериях, выполненных в острой стадии инсульта после проведенного системного тромболизиса и без него.…”

unclassified

See 2 more Smart Citations

Internal carotid artery repair in acute stage of ischemic stroke after thrombolysis

Loluev¹,

Pryamikov²,

Миронков³

et al. 2018

Kardiol. serdechno-sosud. khir.

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Researches devoted to the problem of effectiveness and safety of «early» carotid arteries repair after thrombolysis in ischemic stroke are reviewed in the article. It was shown that most of the trials reported similar incidence of complications including intracranial hemorrhage and mortality in comparison with «early» interventions without thrombolytic therapy in acute stage of stroke. However, small number of publications, no randomized trials and unambiguous recommendations dictate the need for further study of this problem.

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Tailored Approach to Secondary Prevention After Stroke

Sarfo,

Ovbiagele

2024

Ischemic Stroke Therapeutics

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Safety of Early Carotid Endarterectomy after Intravenous Thrombolysis in Acute Ischemic Stroke

Cited by 12 publications

References 35 publications

Prior Intravenous Stroke Thrombolysis Does Not Increase Complications of Carotid Endarterectomy

Prior Intravenous Stroke Thrombolysis Does Not Increase Complications of Carotid Endarterectomy

Internal carotid artery repair in acute stage of ischemic stroke after thrombolysis

Tailored Approach to Secondary Prevention After Stroke

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