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Early carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke.
Eur J Vasc Endovasc Surg. 2009 May; 37(5):512-8.EJ

Abstract

After intravenous thrombolysis (IVT) for acute ischaemic stroke (AIS), a severe cervical internal carotid artery (ICA) stenosis may remain and increase the risk of recurrent stroke. Carotid endarterectomy (CEA) has been shown to be effective in reducing the risk of stroke. However, it is not well known whether CEA can be performed safely after thrombolysis, and, if so, when. We report a prospective study of CEA for residual high-grade cervical ICA stenosis performed within 15 days after IVT for AIS.

METHODS

All the patients had a brain magnetic resonance imaging (MRI) within 3h of the stroke onset. One day after IVT in neurovascular unit, computed tomography (CT) angiography was performed to assess the brain and the patency of cervical arteries. CEA was performed on neurologically stable patients after full cerebral artery re-canalisation. Blood pressure was controlled with particular caution before and after CEA.

RESULTS

Between January 2005 and January 2008, we operated consecutively on 12 patients. Their median National Institutes of Health Stroke Scale (NIHSS) score was 12 (range: 5-21). Combined intracranial (ICA)-middle cerebral artery (MCA) occlusion was present in 58.3% of the patients. The median time between onset of symptoms until CEA was 8 days (range: 1-16 days). Stroke and death rate at 30 days was 8.3% (one nonfatal haemorrhagic stroke). At 90 days, nine patients had a Rankin score of 0-1, one had a score of 2 and two had a score of 3.

CONCLUSION

In patients with residual cervical ICA stenosis after IVT, we achieved full patency of the occluded artery and good functional prognosis at 3 months in all cases. We advocate for an extremely close monitoring of the blood pressure in the pre-, peri- and post-operative course and a close collaboration between neurologist and surgeon to determine the best timing for CEA.

Authors+Show Affiliations

Faculté de Médecine de Marseille, Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille, Hôpital de la Timone, Service de Chirurgie Vasculaire, 13005 Marseille, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19231256

Citation

Bartoli, M A., et al. "Early Carotid Endarterectomy After Intravenous Thrombolysis for Acute Ischaemic Stroke." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 37, no. 5, 2009, pp. 512-8.
Bartoli MA, Squarcioni C, Nicoli F, et al. Early carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke. Eur J Vasc Endovasc Surg. 2009;37(5):512-8.
Bartoli, M. A., Squarcioni, C., Nicoli, F., Magnan, P. E., Malikov, S., Berger, L., Lerussi, G. B., & Branchereau, A. (2009). Early carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 37(5), 512-8. https://doi.org/10.1016/j.ejvs.2008.12.018
Bartoli MA, et al. Early Carotid Endarterectomy After Intravenous Thrombolysis for Acute Ischaemic Stroke. Eur J Vasc Endovasc Surg. 2009;37(5):512-8. PubMed PMID: 19231256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke. AU - Bartoli,M A, AU - Squarcioni,C, AU - Nicoli,F, AU - Magnan,P-E, AU - Malikov,S, AU - Berger,L, AU - Lerussi,G B, AU - Branchereau,A, Y1 - 2009/02/20/ PY - 2008/09/02/received PY - 2008/12/25/accepted PY - 2009/2/24/entrez PY - 2009/2/24/pubmed PY - 2009/5/15/medline SP - 512 EP - 8 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 37 IS - 5 N2 - UNLABELLED: After intravenous thrombolysis (IVT) for acute ischaemic stroke (AIS), a severe cervical internal carotid artery (ICA) stenosis may remain and increase the risk of recurrent stroke. Carotid endarterectomy (CEA) has been shown to be effective in reducing the risk of stroke. However, it is not well known whether CEA can be performed safely after thrombolysis, and, if so, when. We report a prospective study of CEA for residual high-grade cervical ICA stenosis performed within 15 days after IVT for AIS. METHODS: All the patients had a brain magnetic resonance imaging (MRI) within 3h of the stroke onset. One day after IVT in neurovascular unit, computed tomography (CT) angiography was performed to assess the brain and the patency of cervical arteries. CEA was performed on neurologically stable patients after full cerebral artery re-canalisation. Blood pressure was controlled with particular caution before and after CEA. RESULTS: Between January 2005 and January 2008, we operated consecutively on 12 patients. Their median National Institutes of Health Stroke Scale (NIHSS) score was 12 (range: 5-21). Combined intracranial (ICA)-middle cerebral artery (MCA) occlusion was present in 58.3% of the patients. The median time between onset of symptoms until CEA was 8 days (range: 1-16 days). Stroke and death rate at 30 days was 8.3% (one nonfatal haemorrhagic stroke). At 90 days, nine patients had a Rankin score of 0-1, one had a score of 2 and two had a score of 3. CONCLUSION: In patients with residual cervical ICA stenosis after IVT, we achieved full patency of the occluded artery and good functional prognosis at 3 months in all cases. We advocate for an extremely close monitoring of the blood pressure in the pre-, peri- and post-operative course and a close collaboration between neurologist and surgeon to determine the best timing for CEA. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/19231256/Early_carotid_endarterectomy_after_intravenous_thrombolysis_for_acute_ischaemic_stroke_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(08)00698-9 DB - PRIME DP - Unbound Medicine ER -