Intravenous tissue-type plasminogen activator therapy is an independent risk factor for symptomatic intracerebral hemorrhage after carotid endarterectomy

Neurosurgery
Ananth K VellimanaGregory J Zipfel

Abstract

Carotid endarterectomy (CEA) for symptomatic carotid artery stenosis and intravenous tissue-type plasminogen activator (IV-tPA) for acute ischemic stroke are proven therapies; however, the safety of CEA in stroke patients who recently received IV-tPA has not been established. To evaluate the safety of CEA in stroke patients who recently received IV-tPA. A retrospective review of patients who underwent CEA for symptomatic carotid artery stenosis was performed. The primary end point was postoperative symptomatic intracerebral hemorrhage (sICH). A univariate analysis of potential risk factors for sICH, including IV-tPA therapy, timing of CEA, degree of stenosis, and stroke severity, was performed. Factors with a value of P < .1 on univariate analysis were tested further. Among 142 patients, 3 suffered sICH after CEA: 2 of 11 patients treated with IV-tPA (18.2%) and 1 of 131 patients not treated with IV-tPA (0.8%). Both IV-tPA patients suffering sICH underwent CEA within 3 days of tPA administration. On univariate analysis, IV-tPA (P = .02), female sex (P = .09), shorter time between ischemic event and CEA (P = .06), and lower mean arterial pressure during the first 48 hours of admission (P = .08) were identified as risk factors fo...Continue Reading

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Citations

Dec 3, 2014·Clinical Neurology and Neurosurgery·Mark R VillwockEric M Deshaies
Sep 25, 2015·Expert Review of Cardiovascular Therapy·A Ross Naylor
Sep 29, 2015·Journal of Vascular Surgery·Hernan A BazanW Charles Sternbergh
Apr 28, 2016·Neurosurgical Review·Kazuhide AdachiYuichi Hirose
Nov 15, 2017·Neurosurgery·Ananth K VellimanaGregory J Zipfel
Apr 1, 2020·The Journal of Cardiovascular Surgery·Clayton J Brinster, W Charles Sternbergh

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