Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Eur J Vasc Endovasc Surg. 2013 Jun;45(6):573-7. doi: 10.1016/j.ejvs.2013.02.020. Epub 2013 Apr 10.
Intravenous thrombolysis (IVT) has proven effective in the treatment of acute cerebral ischaemic attack in selected cases. In the presence of a carotid artery stenosis, such patients may be candidates for carotid endarterectomy (CEA). Few studies have been made on the safety of CEA performed after IVT.
This was a retrospective study. Data including 30 days' follow-up were obtained from medical records and from a vascular registry.
A consecutive series of 306 patients were operated on for symptomatic carotid artery stenosis during a 5-year period. Among these, 22 (7%) patients had been treated with IVT for an acute cerebral ischaemic attack prior to CEA and 284 (93%) patients had CEA only.
IVT as well as CEA was performed following established guidelines. CEA was performed in median 11 days (25 and 75% percentiles: 7-13 days) after the neurological index event in patients having undergone IVT and 12 days (25 and 75% percentiles: 8-21 days) in patients undergoing CEA only.
The 30 days' stroke and death rate was 0% (95% confidence interval (CI): 0-15%) in patients who had IVT before CEA and 2.4% (95% CI: 0.9-4.7%) in patients who underwent CEA only.
Our experience indicates that CEA performed after IVT for acute cerebral ischaemic attack is safe, confirming existing but sparse publications. However, our series is small and our study possesses a number of limitations. Thus, our results cannot necessarily be transferred to other units, who instead should perform similar studies, preferably together.
静脉溶栓（IVT）已被证明在某些情况下对急性脑缺血性发作的治疗有效。在颈动脉狭窄的情况下，这些患者可能是颈动脉内膜切除术（CEA）的候选者。很少有研究关注 IVT 后进行 CEA 的安全性。
这是一项回顾性研究。数据包括从病历和血管登记处获得的 30 天随访。
在 5 年期间，连续对 306 例症状性颈动脉狭窄患者进行了手术。其中，22 例（7%）患者在 CEA 前因急性脑缺血性发作接受了 IVT 治疗，284 例（93%）患者仅接受了 CEA。
IVT 和 CEA 均按照既定指南进行。在接受 IVT 的患者中，CEA 在神经学指数事件后中位数 11 天（25%和 75%分位数：7-13 天）进行，在仅接受 CEA 的患者中，CEA 在 12 天（25%和 75%分位数：8-21 天）进行。
在接受 IVT 后进行 CEA 的患者中，30 天的卒中率和死亡率为 0%（95%置信区间（CI）：0-15%），而仅接受 CEA 的患者为 2.4%（95% CI：0.9-4.7%）。
我们的经验表明，急性脑缺血性发作后进行 IVT 后进行 CEA 是安全的，证实了现有的但稀少的出版物。然而，我们的系列较小，我们的研究存在一些局限性。因此，我们的结果不一定可以推广到其他单位，而其他单位应该进行类似的研究，最好是联合进行。
