Urgent Carotid Surgery and Stenting May Be Safe After Systemic Thrombolysis for Stroke

Editor's Choice - Safety of Carotid Endarterectomy After Intravenous Thrombolysis for Acute Ischaemic Stroke: A Case-Controlled Multicentre Registry Study

“…In a previous study, Rathenborg et al 8 reported a median delay for IVT þ CEA patients of 11 days and 12 days for CEA alone patients. Koraen-Smith et al 12 reported an interval from index symptom to either CEA or carotid artery stenting (CAS) of 10 days for the IVT þ CEA/CAS group and 9 days for the CEA/CAS alone group among a similar cohort of Swedvasc patients to those in this study. The authors of the present study have no reason to believe that the timing of CEA without IVT should be any different from the timing of CEA after IVT in our study.…”

Thrombolysis is an Independent Risk Factor for Poor Outcome After Carotid Revascularization

“…In previously reported single-institution case series including our own, the incidence of ICH in tPA-treated patients who subsequently underwent CEA ranges from 0% to 18.2%. [6][7][8][9][10][11][12]14,19 In our prior publication, we pooled our institutional data with the then published case series [7][8][9][10][11][12] to calculate an ICH rate of 5.4% for patients treated who received tPA prior to CEA. For patients who did not receive antecedent tPA, the incidence of post-CEA ICH was 0.8% in our previous retrospective study, 6 and 0.2% to 0.6% in other large studies of patients who underwent CEA.…”

“…Three case series have examined the safety of early CAS in patients who have received tPA, and did not find any increase in risk of post-CAS ICH. [13][14][15] Given that all available data examining the issue of safety of CEA or CAS in patients recently treated with tPA stem from relatively small studies, we sought to examine this important issue in a wider study of patients with carotid artery disease. To do so, we employed the Nationwide Inpatient Sample (NIS)-the largest all-payer inpatient healthcare database in the United States.…”

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

“…В работе L. Koraen-Smith и соавт. [18] проведено сравнение групп пациентов, оперированных (КЭЭ и стентирование ВСА) после тромболизиса (n=79) и без него (n=3919). Данные получены на основании анализа Шведского регистра по инсультам.…”

“…Уровень неврологического дефицита при выписке в группе ТЛТ составил 0,5 (от 0 до 4) балла. По данным авторов [18], тромболизис не оказывал влияния на общую частоту осложнений в течение 30 сут. Однако отбор пациентов для КЭЭ или стентирования ВСА после ТЛТ является очень важным и кропотливым процессом.…”