Successful Emergency Carotid Endarterectomy after Thrombolysis with Intravenous Recombinant Tissue-Type Plasminogen...

Area of Science:

• Neurology
• Vascular Surgery
• Emergency Medicine

Background:

• Acute internal carotid artery (ICA) occlusion poses significant risks of severe disability or death.
• Revascularization via carotid artery stenting post-intravenous recombinant tissue-type plasminogen activator (rt-PA) is documented.
• Limited reports exist on emergency carotid endarterectomy (CEA) within 24 hours of rt-PA administration.

Observation:

• A 58-year-old male presented with right ICA occlusion treated with iv rt-PA.
• Partial recanalization was achieved, but severe residual stenosis at the ICA origin persisted, causing fluctuating neurological deficits.
• The patient underwent CEA 10.5 hours after rt-PA treatment to prevent stroke progression.

Findings:

• The emergency CEA procedure was performed without hemorrhagic complications.
• Strict blood pressure control under sedation was maintained during and after the procedure.
• This case demonstrates successful intervention in a complex scenario.

Implications:

• Emergency CEA may be a valuable treatment option for symptomatic severe residual ICA stenosis following acute-stage iv rt-PA therapy.
• This approach could be considered for patients experiencing neurological deficits despite initial thrombolysis.
• Further research is warranted to establish the safety and efficacy of this combined treatment strategy.