Can Carotid Endarterectomy be Performed Safely within 14 days after Intravenous Thrombolysis for Acute Stroke?

Abstract

Carotid endarterectomy (CEA) represents a standard procedure in case of symptomatic carotid stenosis of 50-99% within 2weeks from onset of stroke or transient ischemic attack (TIA) symptoms. The optimal time to perform CEA after intravenous thrombolysis (IVT) is still unclear. The aim of this study was to analyze the safety of CEA performed within 2weeks from IVT. A consecutive series of 70 patients affected by symptomatic carotid stenosis have been treated as per the international guidelines during 3years. Eleven (15.7%) patients have been treated with IVT before CEA for ischemic stroke; remaining 59 (84.3%) patients received only CEA. CEA was performed in median 8days (range: 2-13) after IVT. We examined the grade of disability before and after surgery as well as at 3months follow-up, using the modified Ranking Scale (mRS). Among the patients who underwent CEA+IVT, CEA was performed in median 8days (range: 2-13) after IVT. One patient received CEA within 48hours from IVT, 3 patients within 72hours, and 7 patients within 2weeks. The complications within 90days from surgery, in CEA+IVT group, were 3 cases of intracerebral hemorrhage (ICH) without symptoms. In patients who received only CEA, the complications were 1 case of stroke and 2 cases of ICH. The mortality registered was 0% in both groups. Among CEA+IVT group at 90days after surgery, 9 patients had a mRS grade of 0-2, 2 patients had mRS of 3-5. In our series, IVT before CEA did not seem to increase the rate of complications. However, the study has several limitations, and further studies must be performed before solid evidence is available for recommendations regarding the timing of CEA after IVT.