Early Carotid Endarterectomy for Residual Critical Carotid Artery Stenosis after Intravenous Thrombolysis

Objective: The objective of the study is to contribute to the knowledge regarding the safety of carotid endarterectomy for residual critical interior carotid artery stenosis shortly after intravenous thrombolysis due to acute cerebral stroke. Introduction: In the case of intravenous thrombolysis, reperfusion is achieved by the dilution of the clot without this having an effect on arterial sclerotic changes as such. Homolateral tight residual stenosis of the carotid artery after thrombolysis poses the danger of early recurrence of cerebral infarction and closure of the artery. The timing of carotid endarterectomy after a cerebrovascular accident remains a controversial issue in clinical practice and safe performance of surgery shortly after thrombolysis is uncertain. Method: The authors assess, on a retrospective basis, a group of seven patients for the period from 01/2006 to 05/2008, who underwent early endarterectomy for critical residual stenosis of the homolateral interior carotid artery after intravenous thrombolysis for acute cerebral infarction in the middle cerebral artery, All patients were men aged from 52 to 74. Results: Thrombolysis was successful in all cases, with the neurological picture normalising quickly in three cases and partially in four cases (National Institutes of Health Stroke Scale - 1, 3, 4, 11). CT exam was negative or showed small hypodensity. The patients' neurological findings before the surgery were normal or showing just slight neurological deficit. The surgery (performed at 5th to 1 5th day after thrombolysis [the median being 8], total anesthesia, electrophysiological monitoring) and the post-op course were free from complications. In patients with a neurological deficit prior to surgery further improvement of the deficit was recorded (National Institutes of Health Stroke Scale: 1-0, 3-2, 4-3, 11-6). 30-day morbidity and mortality was nil. No recurrence of cerebral infarction was recorded in the course of a six-month follow-up. Conclusion: Early carotid endarterectomy can be safely performed in the selected group of patients with critical residual stenosis of the interior carotid artery after intravenous thrombolysis for acute schemic cerebral accident.