Carotid endarterectomy after intravenous thrombolysis and mechanical thrombectomy

Aim: Aim of this study was to verify the safety of an early carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) in terms of hemorrhagic, ischemic, and other complications. Material and methods: 65 CEA patients were operated after the IVT or MT. In a prospective study, hemorrhagic, ischemic, and other complications were studied and their relationship to (a) timing of the procedure; ( b) antithrombotic and statin therapy; (c) blood pressure; and (d) imaging and other findings were evaluated. Results: In the group where CEA followed IVT (a) within 6 h: 2 ischemic complications (3.08%) were noted - one periprocedural and one 12 h after CEA, one wound hematoma without revision; (b) 6-12 h: one (1.54%) ischemic stroke 12 h after CEA; (c) 12-24 h: one (1.54%) ischemic stroke 16 h after CEA; (d) 24-72 h: one (1.54%) ischemic stroke 10 h after CEA and two wound hematomas (one with revision); (e) over 14 days: two transient lesions of XIIth and VIIth cranial nerves (3.08%); no postoperative intracerebral hematoma was noted. The total number of ischemic complications in the whole group was 7.7%. The only prognostic factor of postoperative ischemic complication was post- operative arterial hypotension (P = 0.001). Conclusion: Early CEA after IVT is justified to reduce the risk of relapse. The only prognostic factor of ischemic complications development was post-operative arterial hypotension.