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Urgent carotid surgery and stenting may be safe after systemic thrombolysis for stroke.

Abstract：

BACKGROUND AND PURPOSE:Early carotid surgery or stenting after thrombolytic treatment for stroke has become more common during recent years. It is unclear whether this carries an increased risk of postoperative complications and death. The aim of this nationwide population-based study was, therefore, to investigate the safety of urgently performed carotid procedures in patients treated with thrombolysis for stroke. METHODS:Using the national Vascular and Stroke registries, we identified 3998 patients who had undergone carotid endarterectomy or carotid artery stenting for symptomatic carotid stenosis between May 2008 and December 2012. Among these, 2% (79 of 3998) had undergone previous thrombolysis for stroke. We conducted a retrospective review of registry data and individual case records with regard to postoperative complications, including surgical-site bleeding, stroke, and death. The outcome was compared with the results for the remaining patient cohort (3919 of 3998) undergoing carotid surgery and stenting during the study period. RESULTS:The median time between thrombolysis and the carotid procedure was 10 days. Seventy-one patients underwent carotid endarterectomy, and 6 patients underwent carotid artery stenting. The 30-day death and stroke rate for the thrombolysis cohort was 2.5% (2 of 79), and for the whole cohort, it was 3.8% (139 of 3626; P=0.55). The postoperative bleeding rates requiring reoperation were not significantly different between the groups (3.8% [3 of 79] in the thrombolysis group versus 3.3% [119 of 3626] in the whole cohort; P=0.79). There was no correlation between time from lysis to surgery or stenting and complications at 30 days postoperatively. CONCLUSIONS:Urgent carotid endarterectomy or carotid artery stenting after thrombolysis for stroke may be safe without increased risk of serious complications.

journal_name

Stroke

journal_title

Stroke

authors

Koraen-Smith L,Troëng T,Björck M,Kragsterman B,Wahlgren CM,Swedish Vascular Registry and the Riks-Stroke Collaboration.

doi

10.1161/STROKEAHA.113.003763

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

776-80

issue

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.113.003763

journal_volume

pub_type

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Urgent carotid surgery and stenting may be safe after systemic thrombolysis for stroke.