Risk of Stroke Recurrence After Intravenous Thrombolysis in Patients with Symptomatic Carotid Stenosis

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Cardiology

Background:

• Symptomatic severe carotid stenosis poses a significant risk of cerebrovascular events.
• Carotid revascularization (surgery or stenting) is a common treatment for severe carotid stenosis.
• The role of intravenous thrombolysis (IVT) in managing patients awaiting carotid revascularization is not fully understood.

Purpose of the Study:

• To evaluate the impact of IVT on the risk of recurrent cerebrovascular events before carotid intervention.
• To compare the incidence of preoperative ischemic stroke or retinal artery occlusion in IVT-treated versus non-IVT-treated patients with symptomatic carotid stenosis.

Main Methods:

• A merged cohort analysis of three patient groups with symptomatic ≥50% carotid stenosis.
• Exclusion of patients not presenting with stroke on the day of symptom onset to ensure cohort relevance.
• Comparison of preoperative cerebrovascular event risk up to 30 days between IVT-treated and non-IVT-treated cohorts.

Main Results:

• 64 out of 316 patients received IVT; no significant difference in recurrent ipsilateral ischemic stroke or retinal artery occlusion risk at 7 and 30 days.
• A trend towards higher immediate risk (day 0) in the IVT group (6% vs. 1%) was observed, though not statistically significant after adjustment.
• This initial risk increase was offset by a subsequent risk decrease, resulting in no significant difference by day 7.

Conclusions:

• IVT does not appear to significantly affect the overall risk of recurrent ipsilateral ischemic stroke in patients with symptomatic severe carotid stenosis awaiting intervention.
• Both IVT-treated and non-IVT-treated patients face a substantial risk of recurrent events.
• A potential transient increase in risk on the day of IVT administration may be counterbalanced by a decreased risk in the following days.