Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke
Authors:
I. Guňka 1; D. Krajíčková 2; M. Leško 1; S. Jiška 1; A. Hudák 1; L. Šimůnek 2; J. Raupach 3
Authors‘ workplace:
Chirurgická klinika Fakultní nemocnice Hradec Králové a Lékařské fakulty v Hradci Králové
1; Neurologická klinika Fakultní nemocnice Hradec Králové a Lékařské fakulty v Hradci Králové
2; Radiologická klinika Fakultní nemocnice Hradec Králové a Lékařské fakulty v Hradci Králové
3
Published in:
Rozhl. Chir., 2022, roč. 101, č. 8, s. 388-394.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2022.101.7.388–394
Overview
Introduction: Acute symptomatic occlusion of the internal carotid artery (ICA) is associated with unfavorable prognosis. However, no clear definition of its optimal treatment exists. The aim of this study was to evaluate the efficacy and risks of urgent carotid endarterectomy (CEA) in patients with ischemic stroke due to acute extracranial ICA occlusion.
Methods: A retrospective analysis was performed of all consecutive patients undergoing urgent CEA for acute extracranial ICA occlusion during the period from July 2014 to June 2021. The primary outcome was functional independence at three months defined as modified Rankin Scale (mRS) score ≤2. Secondary outcomes included the severity of the neurological deficit at the time of discharge and its comparison with the preoperative condition as assessed using the National Institutes of Health Stroke Scale (NIHSS), the incidence of symptomatic intracerebral hemorrhage (ICH), and 30-day periprocedural mortality.
Results: During the study period, a total of 42 urgent CEAs were performed for acute extracranial ICA occlusions. The median preoperative NIHSS score was 7 (interquartile range [IQR] 5–13). The median time interval between the onset of symptoms and surgery was 290 minutes (IQR 235–340). Technical success rate of urgent CEA was 97.6% (41 patients). The median NIHSS at the time of hospital discharge was 2 (IQR 3–7; p <0.001). An early clinical improvement by ≥2 points was achieved in 36 patients (85.7%). Symptomatic ICH occurred in one patient (2.4%) and one patient (2.4%) died. A good clinical outcome was achieved in 34 patients (81.0%) after three months.
Conclusion: This study demonstrated that patients with ischemic stroke due to acute extracranial ICA occlusion may benefit from urgent CEA.
Keywords:
carotid endarterectomy – stroke – internal carotid artery – occlusion – urgent
Sources
1. Burke MJ, Vergouwen MD, Fang J, et al. Short-term outcomes after symptomatic internal carotid artery occlusion. Stroke 2011;42(9):2419–2424. doi:10.1161/STROKEAHA.111.615278.
2. Paciaroni M, Balucani C, Agnelli G, et al. Systemic thrombolysis in patients with acute ischemic stroke and internal carotid artery occlusion: the ICARO study. Stroke 2012;43(1):125–130. doi:10.1161/ STROKEAHA.111.630624.
3. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 Guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2019;50(12):e344–e418. doi:10.1161/ STR.0000000000000211.
4. Naylor AR, Ricco JB, de Borst GJ, et al. Editor‘s choice – management of atherosclerotic carotid and vertebral artery disease: 2017 Clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):3–81. doi:10.1016/j. ejvs.2017.06.021.
5. Weis-Müller BT, Huber R, Spivak-Dats A, et al. Symptomatic acute occlusion of the internal carotid artery: reappraisal of urgent vascular reconstruction based on current stroke imaging. J Vasc Surg. 2008;47(4):752–759. doi:10.1016/j. jvs.2007.11.042.
6. Beneš V 3rd, Buchvald P, Klimošová S, et al. Acute extracranial occlusion of the internal carotid artery: emergent surgery remains a viable option. Acta Neurochir (Wien). 2014;156(5):901–908. doi:10.1007/s00701-014-2036-6.
7. Gunka I, Krajickova D, Lesko M, et al. Emergent carotid thromboendarterectomy for acute symptomatic occlusion of the extracranial internal carotid artery. Vasc Endovascular Surg. 2017;51(4):176– 182. doi:10.1177/1538574416674641.
8. Schubert J, Witte OW, Settmacher U, et al. Acute stroke treatment by surgical recanalization of extracranial internal carotid artery occlusion: A single center experience. Vasc Endovascular Surg. 2019;53(1):21–27. doi:10.1177/1538574418800131.
9. Jauch EC, Saver JL, Adams HP Jr. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2013;44(3):870–947. doi:10.1161/ STR.0b013e318284056a.
10. Wardlaw JM, Murray V, Berge E, et al. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2014 J;2014(7):CD000213. doi:10.1002/14651858.CD000213.
11. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–2295. doi:10.1056/ NEJMoa1415061.
12. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–1030. doi:10.1056/NEJMoa1414905.
13. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. doi:10.1056/ NEJMoa1411587.
14. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–1018. doi:10.1056/NEJMoa1414792.
15. Hause S, Oldag A, Breja A, et al. Acute symptomatic extracranial internal carotid occlusion – natural course and clinical impact. Vasa 2020;49(1):31–38. doi:10.1024/0301-1526/a000826.
16. Pechlaner R, Knoflach M, Matosevic B, et al. Recanalization of extracranial internal carotid artery occlusion after i.v. thrombolysis for acute ischemic stroke. PLoS One 2013;8(1):e55318. doi:10.1371/journal. pone.0055318.
17. Klijn CJ, Kappelle LJ, Tulleken CA, et al. Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. Stroke 1997;28(10):2084–2093. doi:10.1161/01.str.28.10.2084.
18. Bhatia R, Hill MD, Shobha N, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 2010;41(10):2254–2258. doi:10.1161/ STROKEAHA.110.592535.
19. Christou I, Felberg RA, Demchuk AM, et al. Intravenous tissue plasminogen activator and flow improvement in acute ischemic stroke patients with internal carotid artery occlusion. J Neuroimaging 2002;12(2):119– 123. doi:10.1111/j.1552-6569.2002. tb00107.x.
20. Romoli M, Mosconi MG, Pierini P, et al. Reperfusion strategies in stroke due to isolated cervical internal carotid artery occlusion: systematic review and treatment comparison. Neurol Sci. 2021;42(6):2301–2308. doi:10.1007/ s10072-020-04735-5.
21. Mokin M, Kass-Hout T, Kass-Hout O, et al. Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. Stroke 2012;43(9):2362–2368. doi:10.1161/STROKEAHA.112.655621.
22. Jadhav A, Panczykowski D, Jumaa M, et al. Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion. J Neurointerv Surg. 2018;10(12):1155–1160. doi:10.1136/ neurintsurg-2018-013810.
23. Beneš V 3rd, Bradáč O, Horváth D, et al. Surgery of acute occlusion of the extracranial internal carotid artery – a meta-analysis. Vasa 2020;49(1):6–16. doi:10.1024/0301-1526/a000801.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2022 Issue 8
Most read in this issue
- Complications and pitfalls of endovenous laser therapy for varicose veins of lower extremities
- Unique robotic vascular surgery procedures
- Endovenous laser ablation of saphenous veins – favorable clinical results confirm theoretical advantages of the 1940nm diode laser
- Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke