Early Carotid Endarterectomy for Residu al Critical Carotid Artery Stenosis after Intraveno us Thrombolysis

Czech version

Authors: J. Mraček ¹; I. Holečková ¹; J. Mork ¹; P. Ševčík ²; V. Rohan ²
Authors‘ workplace: Ne urochirurgické oddělení LF UK a FN Plzeň, 2Ne urologická klinika LF UK a FN Plzeň ¹
Published in: Cesk Slov Neurol N 2009; 72/105(2): 173-177
Category: Short Communication

Overview

Objective:
The objective of the study is to contribute to the knowledge regarding the safety of carotid endarterectomy for residu al critical interi or carotid artery stenosis shortly after intraveno us thrombolysis due to acute cerebral stroke.

Introducti on:
In the case of intraveno us thrombolysis, reperfusi on is achi eved by the diluti on of the clot witho ut this having an effect on arteri al sclerotic changes as such. Homolateral tight residu al stenosis of the carotid artery after thrombolysis poses the danger of e arly recurrence of cerebral infarcti on and closure of the artery. The timing of carotid endarterectomy after a cerebrovascular accident remains a controversi al issue in clinical practice and safe performance of surgery shortly after thrombolysis is uncertain.

Method:
The a uthors assess, on a retrospective basis, a gro up of seven pati ents for the peri od from 01/ 2006 to 05/ 2008, who underwent e arly endarterectomy for critical residu al stenosis of the homolateral interi or carotid artery after intraveno us thrombolysis for acute cerebral infarcti on in the middle cerebral artery. All pati ents were men aged from 52 to 74.

Results:
Thrombolysis was successful in all cases, with the ne urological picture normalising quickly in three cases and parti ally in fo ur cases (Nati onal Institutes of He alth Stroke Scale – 1, 3, 4, 11). CT exam was negative or showed small hypodensity. The pati ents’ ne urological findings before the surgery were normal or showing just slight ne urological deficit. The surgery (performed at 5th to 15th day after thrombolysis [the medi an being 8], total anesthesi a, electrophysi ological monitoring) and the post‑op co urse were free from complicati ons. In pati ents with a ne urological deficit pri or to surgery further improvement of the deficit was recorded (Nati onal Institutes of He alth Stroke Scale: 1– 0, 3– 2, 4– 3, 11– 6). 30- day morbidity and mortality was nil. No recurrence of cerebral infarcti on was recorded in the co urse of a six- month follow‑up.

Conclusi on:
Early carotid endarterectomy can be safely performed in the selected gro up of pati ents with critical residu al stenosis of the interi or carotid artery after intraveno us thrombolysis for acute ischemic cerebral accident.

Key words:
carotid artery stenosis – carotid endarterectomy – timing – thrombolysis – stroke

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