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Prior Intravenous Stroke Thrombolysis Does Not Increase Complications of Carotid Endarterectomy

Petra Ijäs1,2, Ellinoora Aro3, Henrietta Eriksson1

  • 1From the Department of Neurology (P.I., H.E., L.S.).

Stroke
|July 12, 2018
PubMed

Insights

Carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) is safe, with timing not affecting complications. However, stroke recurrence during the waiting period highlights the need for prompt surgical intervention after IVT.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Cardiology

Background:

  • Carotid endarterectomy (CEA) is a standard procedure for stroke prevention.
  • The optimal timing for CEA after intravenous thrombolysis (IVT) for acute ischemic stroke is not well-established.
  • Balancing the risk of stroke recurrence against CEA-related complications is crucial.

Purpose of the Study:

  • To evaluate the safety of CEA performed after IVT.
  • To assess the incidence of stroke recurrence and CEA-related complications in patients who received IVT before CEA.
  • To compare outcomes of early (<48 hours) versus later CEA after IVT.

Main Methods:

  • Retrospective analysis of prospectively collected data from Helsinki University Hospital (2005-2016).
  • Inclusion of patients who underwent IVT followed by CEA.
  • Comparison with a control group of CEA patients without preceding IVT.
  • Recording of stroke recurrence, peri/postoperative complications (stroke, hyperperfusion syndrome, hypertension, hematoma, myocardial infarction), and 3-month functional outcome (modified Rankin Scale).

Main Results:

  • 128 patients underwent CEA after IVT; 777 underwent CEA without IVT.
  • Median time from IVT to CEA was 9 days.
  • Stroke recurrence rate was 5.5% in the IVT-CEA group.
  • Outcomes (ischemic/hemorrhagic stroke, hematoma, MI, mRS) did not significantly differ between early (<48 hours) and later CEA after IVT.
  • A trend towards higher hyperperfusion syndrome incidence was observed with early CEA (20.0% vs. 6.5%, P=0.070).
  • CEA-related stroke rates were similar between groups.
  • Smoking was the only significant predictor of peri/postoperative stroke (OR 21.82).

Conclusions:

  • The time interval between IVT and CEA was not associated with increased CEA-related complications.
  • The study emphasizes the risk of stroke recurrence during the waiting period for CEA, advocating for reduced surgical delays.
  • Early CEA (<48 hours) after IVT appears safe, though hyperperfusion syndrome warrants monitoring.

Keywords:
hematomahypertensionincidencemyocardial infarctionsmoking

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