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Carotid approaches found safe after thrombolysis for stroke
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Urgent carotid artery stenting and endarterectomy were associated with similar 30-day mortality and stroke rates in stroke patients treated with or without thrombolysis.
Despite more common use in recent years, uncertainty still surrounds early carotid surgery or stenting after thrombolytic treatment for stroke. This approach may be associated with increased risk of postoperative complications or mortality.
Investigators identified 3,998 patients treated with thrombolysis for stroke who had undergone urgently performed carotid procedures between May 2008 and December 2012. Data were culled from the national Vascular and Stroke registries, and included individuals who had received carotid endarterectomy or carotid artery stenting for symptomatic carotid stenosis. The retrospective review involved individual case records containing information on postoperative complications such as bleeding at the surgical site, stroke and death, according to the results.
Two percent of the cohort had previously undergone thrombolysis to treat stroke. Outcomes in this group were compared with those for the other 3,919 patients who underwent carotid surgery and stenting.
The investigators reported that 10 days was the median duration between thrombolysis and the carotid procedure.
Carotid endarterectomy was performed in 71 patients, while 6 underwent carotid artery stenting.
In the thrombolysis group (n=79), the 30-day stroke and mortality rate was 2.5% compared with 3.8% (P=.55) for the whole cohort (n=3,626).
There was no significant difference between the thrombolysis group and the whole cohort in terms of postoperative bleeding rates requiring reoperation. This rate was 3.8% for the thrombolysis group and 3.3% for the whole cohort (P=.79).
No association existed between time from lysis to surgery or stenting and complications at the 30-day mark, according to the findings.
“Urgent carotid endarterectomy or carotid artery stenting after thrombolysis for stroke may be safe without increased risk of serious complications,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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