Carotid endarterectomy in early period after systemic thrombolysis for acute cerebrovascular accident

Vinokurov I.A.; Yasnopolskaya N.V.; Gasanov E.N.; Mutaev O.M.; Ropova A.I.

doi:https://doi.org/10.17116/kardio202114051370

Vinokurov I.A.

Petrovsky Russian Research Center of Surgery;
Sechenov First Moscow State Medical University

ORCID: 0000-0003-0433-2523

Yasnopolskaya N.V.

Yudin Moscow City Clinical Hospital

ORCID: 0000-0002-4388-7890

Gasanov E.N.

Topchibashov Research Center of Surgery

Mutaev O.M.

Sechenov First Moscow State Medical University

Ropova A.I.

Sechenov First Moscow State Medical University

Carotid endarterectomy in early period after systemic thrombolysis for acute cerebrovascular accident

Authors:

Vinokurov I.A., Yasnopolskaya N.V., Gasanov E.N., Mutaev O.M., Ropova A.I.

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Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(5): 370‑375

DOI: 10.17116/kardio202114051370

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To cite this article:

Vinokurov IA, Yasnopolskaya NV, Gasanov EN, Mutaev OM, Ropova AI. Carotid endarterectomy in early period after systemic thrombolysis for acute cerebrovascular accident. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(5):370‑375. (In Russ.)
https://doi.org/10.17116/kardio202114051370

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To estimate the results of carotid endarterectomy in early period after systemic thrombolysis.

MATERIAL AND METHODS

The study included 69 patients who underwent carotid endarterectomy within 14 days after stroke. The main group consisted of 15 patients (thrombolysis followed by carotid endarterectomy), the control group — 54 patients (no thrombolysis before carotid endarterectomy). Mean age of patients in the 1^st group was 71±7.9 years, in the second group — 67.6±8.6 years. Patients were comparable by comorbidities.

RESULTS

Systemic thrombolysis increased time to carotid endarterectomy by 2.2 days (p<0.017). We found no between-group difference in the incidence of postoperative complications. Mortality after carotid endarterectomy had a strong correlation with recurrent stroke and bleeding (r=0.71, p<0.05). No correlation was found between postoperative bleeding and antiplatelet therapy and thrombolysis within 7—14 days after ischemic stroke. At the same time, only postoperative complications affected treatment outcomes, and the factors of patients’ preoperative condition were not associated with higher mortality.

CONCLUSION

Carotid endarterectomy within 14 days after ischemic stroke did not increase the number of complications in patients with previous thrombolysis.

Keywords:

acute cerebrovascular accident

stroke

carotid endarterectomy

thrombolytic therapy

Authors:

Vinokurov I.A.

Petrovsky Russian Research Center of Surgery;
Sechenov First Moscow State Medical University

ORCID: 0000-0003-0433-2523

Yasnopolskaya N.V.

Yudin Moscow City Clinical Hospital

ORCID: 0000-0002-4388-7890

Gasanov E.N.

Topchibashov Research Center of Surgery

Mutaev O.M.

Sechenov First Moscow State Medical University

Ropova A.I.

Sechenov First Moscow State Medical University

Received:

14.06.2021

Accepted:

10.07.2021

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References:

Naylor AR, et al. Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2018;55:1:3-81. https://doi.org/10.1016/j.ejvs.2017.06.021
Deiana G, Baule A, Caneva PD, et al. Can Carotid Endarterectomy be Performed Safely within 14 days after Intravenous Thrombolysis for Acute Stroke? Ann Vasc Surg. 2020;66:385-389. https://doi.org/10.1016/j.avsg.2019.12.038
Eckstein HH. Editorial on «Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry». Eur J Vasc Endovasc Surg. 2016;52:425-426. https://doi.org/10.1016/j.ejvs.2016.07.085
Clinical guidelines for the management of thrombolytic therapy in ischemic stroke of the All-Russian Society of Neurologists and the National Association for Stroke Control. Project coordinators: Gusev E.I., Skvortsova V.I., 2015;49. (In Russ.).
Maksimova MYu, Fonyakin AV, Geraskina LA. Ischemic stroke and antithrombotic therapy: key aspects of application. Medical consil. 2019;18:10-17. (In Russ.). https://doi.org/10.21518/2079-701X-2019-18-10-17
Diener H-C, Bogousslavsky J, Brass L, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomized, double-blind, placebo-controlled trial. Lancet. 2004;364:331-337. https://doi.org/10.1016/S0140-6736(04)16721-4
Zakirzhanov NR, Komarov RN, Khalilov IG, Bayazova NI, Evseeva VV. Cerebral hyperperfusion syndrome after carotid endarterectomy in acute period of ischemic stroke. Angiologiya i Sosudistaya Khirurgiya. 2021;4:97-106. (In Russ.). https://doi.org/10.33529/ANGIO2021103
Kazantsev AN, Burkov NN, Tarasov RS, Anufriev AI, Shabaev AR, Ruban EV, Mironov AV, Kheraskov VYu. Carotid endarterectomy in acute period of ischemic stroke. Patologiya Krovoobrashcheniya i Kardiokhirurgiya. 2018;22:1:66-72. (In Russ.). https://doi.org/10.21688/1681-3472-2018-1-66-72
Kazantsev AN, Porkhanov VA, Khubulava GG, et al. Comparative results of emergency carotid endarterectomy and carotid angioplasty with stenting in acute period of ischemic stroke. Results of a multiple-center study. Sklifosovsky Journal «Emergency Medical Care». 2021;10:1:33-47. (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-1-33-47
Naylor AR. Thrombolysis and expedited carotid revascularization. J Cardiovasc Surg. 2015;56:159-164.
Matyushkin AV, Mustafin AH. Results of carotid endarterectomy in the treatment of patients with ischemic stroke. Pirogov Journal of Surgery. 2021;3:50-56. (In Russ.). https://doi.org/10.17116/hirurgia202103150
Zakirzhanov NR, Komarov RN, Khalilov IG. Surgical revascularization of the carotid basin in acute period of ischemic stroke. Pirogov Journal of Surgery. 2020;2:74-78. (In Russ.). https://doi.org/10.17116/hirurgia202002174
Bartoli MA, Squarcioni C, Nicoli F, Magnan P-E, Malikov S, Berger L, Lerussi GB, Branchereau A. Early Carotid Endarterectomy after Intravenous Thrombolysis for Acute Ischaemic Stroke 2009 European Society for Vascular Surgery. 2009;49:5:1360. https://doi.org/10.1016/j.ejvs.2008.12.018
van Dellen D, Tiivas CAS, Jarvi K, Marshall C, Higman DJ, Imray CHE. Transcranial Doppler ultrasonography-directed intravenous glycoprotein IIb/IIIa receptor antagonist therapy to control transient cerebral microemboli before and after carotid endarterectomy. Br J Surg. 2008;95:6:709-713. https://doi.org/10.1002/bjs.6204
Clinical guidelines «Ischemic stroke and transient ischemic attack in adults» All-Russian Society of Neurologists National, Association for Stroke Control, Association of Neurosurgeons of Russia, Union of Rehabilitation Specialists of Russia, 2020. (In Russ.).
Popov AP, Gasparyan MV, Shakhnazaryan AM, Kutischeva NG. Results of surgical treatment of carotid artery stenosis in acute period of ischemic stroke. Bulletin of the Pirogov National Medical and Surgical Center. 2013;8:2:24-28. (In Russ.).
Vellimana AK, Yarbrough CK, Blackburn S, Strom RG, Pilgram TK, Lee J-M, Zipfel GJ. Intravenous Tissue-Type Plasminogen Activator Therapy Is an Independent Risk Factor for Symptomatic Intracerebral Hemorrhage After Carotid Endarterectomy. Neurosurgery. 2014;74:3:254-261. https://doi.org/10.1227/neu.0000000000000261