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Updated: May 30, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Safety of early carotid artery stenting after systemic thrombolysis: a single center experience
Fabrizio Sallustio1, Giacomo Koch, Alessandro Rocco
1Department of Clinical Neurological Sciences, Stroke Unit, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Insights
Early carotid artery stenting (CAS) after IV thrombolysis is safe for acute ischemic stroke patients with severe internal carotid artery disease. This approach demonstrated good stent patency and favorable outcomes, suggesting it as a viable secondary stroke prevention strategy.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Patients with acute ischemic stroke from internal carotid artery (ICA) disease face a high risk of recurrent strokes.
- Combining intravenous thrombolysis with early carotid artery stenting (CAS) may offer improved secondary stroke prevention.
- This study evaluates the safety and durability of early CAS in patients with residual ICA stenosis after thrombolysis.
Purpose of the Study:
- To assess the safety and durability of performing early carotid artery stenting (CAS) after intravenous thrombolysis in patients with acute ischemic stroke and residual internal carotid artery stenosis.
- To determine the feasibility of this combined treatment approach in a high-risk patient population.
Main Methods:
- Retrospective analysis of consecutive patients treated with IV rtPA (alteplase) who subsequently underwent early CAS (>24 hours) for residual ICA stenosis (≥70% or <70% with ulcerated plaque).
- Pre-procedure imaging included MRI and MR angiography; post-procedure imaging included carotid ultrasound and CT angiography.
- Stroke severity was measured using the NIH Stroke Scale (NIHSS); stent patency and functional outcomes were assessed at 3 and 12 months using ultrasound and the modified Rankin Scale (mRS), respectively.
Main Results:
- Out of 145 IV rtPA-treated patients, 6 (4%) underwent early CAS. The median age was 76 years, with a median NIHSS of 12 at onset and 7 before CAS.
- The median time from stroke onset to CAS was 48 hours. All procedures involved a single self-expandable stent and were uneventful.
- At 12 months, all stents remained patent, and 5 out of 6 patients had favorable functional outcomes (mRS ≤ 2). One patient experienced a recurrent stroke due to new-onset atrial fibrillation.
Conclusions:
- Early carotid artery stenting (CAS) following IV thrombolysis appears to be a safe and effective option for selected acute ischemic stroke patients with significant internal carotid artery stenosis.
- This strategy shows promising results in terms of stent patency and functional outcomes, potentially reducing the risk of early stroke recurrence.
- Further research in larger cohorts is warranted to confirm these findings and establish optimal treatment protocols.
Abstract:
Background. Patients with acute ischemic stroke due to internal carotid artery (ICA) disease are at high risk of early stroke recurrence. A combination of IV thrombolysis and early carotid artery stenting (CAS) may result in more effective secondary stroke prevention. Objective. We tested safety and durability of early CAS following IV thrombolysis in stroke patients with residual stenosis in the symptomatic ICA. Methods. Of consecutive patients treated with IV rtPA, those with residual ICA stenosis ≥70% or <70% with an ulcerated plaque underwent early CAS (>24 hours). The protocol included pre-rtPA MRI and MR angiography, and post-rtPA carotid ultrasound and CT angiography. Stroke severity was assessed by the NIH Stroke Scale (NIHSS). Three- and twelve-month stent patency was assessed by ultrasound. Twelve-month functional outcome was assessed by the modified Rankin Scale (mRS). Results. Of 145 consecutive IV rtPA-treated patients, 6 (4%) underwent early CAS. Median age was 76 (range 67-78) years, median NIHSS at stroke onset was 12 (range 9-16) and 7 (range 7-8) before CAS. Median onset-to-CAS time was 48 (range 30-94) hours. A single self-expandable stent was implanted to cover the entire lesion in all patients. The procedure was uneventful in all patients. After 12 months, all patients had stent patency, and the functional outcome was favourable (mRS ≤ 2) in all but 1 patient experiencing a recurrent stroke for new-onset atrial fibrillation. Conclusion. This small case series of a single centre suggests that early CAS may be considered a safe alternative to CEA after IV rtPA administration in selected patients at high risk of stroke recurrence.
