Timing of carotid endarterectomy after intravenous thrombolysis and mechanical thrombectomy
EANS Academy. Sames M. 09/27/19; 276076; EP01145
Prof. Dr. Martin Sames
Prof. Dr. Martin Sames

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Background: To verify the safety of early carotid endarterectomies after IVT or mechanical thrombectomy in terms of hemorrhage and other complications.
Patients and methods: All 38 carotid endarterectomies operated after the administration of intravenous thrombolysis (from 2012-2018 at the Neurosurgical Clinic of Masaryk Hospital, Ústí nad Labem, Czech Republic) were divided into the groups according to time interval between the IVT and surgery. Retrospectively, any complications, with stress to hemorhagic and ischemic ones and their relationship to timing and other variables from personal history of patients, MR DW and CT findings were evaluated.
Results: In the group where CEA followed IVT: (a) within 6 hours: 2 ischemic complications (33%) were recorded - one ischemic stroke periprocedurally and one 12 hrs. after surgery, (b) 6-12 hrs: one (33%) complication with symptomatic arterial occlusion 12 hrs. after CEA, (c) 12 - 24 hrs: no complications, (d) 24 - 72 hrs.: two wound hematomas were recorded (29%), one required a revision, (e) 72 hrs. - 3 days: no complications, (f) over 14 days: two transient palsies of XII. and VII. cranial nerves were seen (15%). The total number of major complications in this group was 7.9%. All major events were of thromboembolic origin and in cases where surgery took place within 12 hours from IVT.
Conclusion: Early CEA surgeries following IVT administration are not burdened with a higher risk of hemorrhagic complications. We recorded a higher number of complications - brain ischemic events - in the groups where surgery followed IVT within 12 hours. It is necessary to verify the possible association of the procoagulant effect of thrombolysis with perioperative ischemic stroke during the first 12 hours following its administration.
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