Emergent Carotid Endarterectomy Is Associated with Good 3-month Clinical Outcomes and Low 3-month Mortality in Patients with Acute Ischemic Stroke and Acute Cervical Internal Carotid Artery Occlusion
Roman Herzig1, Igor Gunka2, Svatopluk Ostry3, Jiri Fiedler4, Vladimir Priban5, Martin Kovar6, Petr Stadler7, Ondrej Škoda8, Jiri Neumann9, Veronika Kunesova10
1Department of Neurology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, 2Department of Surgery, University Hospital Hradec Kralove, 3Department of Neurology, Comprehensive Stroke Centre, Ceske Budejovice Hospital, 4Department of Neurosurgery, Comprehensive Stroke Center, Ceske Budejovice Hospital, 5Department of Neurosurgery, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, 6Department of Neurology, Comprehensive Stroke Center, Na Homolce Hospital, Prague, 7Department of Vascular Surgery, Na Homolce Hospital, Prague, 8Department of Neurology, Jihlava Hospital, 9Department of Neurology, Krajska zdravotni – Hospital Chomutov, 10Cerebrovascular Research Program, International Clinical Research Center, Brno
Objective:
To assess the safety and efficacy of intravenous thrombolysis (IVT), emergent carotid endarterectomy (CEA), and IVT+CEA in patients with acute ischemic stroke and acute cervical internal carotid artery (ICA) occlusion.
Background:
Acute ischemic stroke in acute cervical ICA occlusion is often associated with a severe and persistent neurological deficit and a high mortality rate. IVT is the only standard treatment method. An emergent CEA used alone or in combination with IVT represents an experimental alternative.
Design/Methods:
In a retrospective, multicentre study, the IVT group consisted of 41 patients (26 males; median age 72 [60–79] years), the IVT+CEA group of 31 patients (26 males; median age 70 [63–77] years), and the CEA group of 61 patients (45 males; median age 68 [61–75] years). Neurological deficit was assessed using the National Institutes of Health Stroke Scale (NIHSS) on admission and after 24 h and 3-month modified Rankin Scale (mRS – with good clinical outcome defined as mRS 0–3). Logistic regression analysis was used to identify independent predictors of the achievement of good 3-month clinical outcomes and 3-month mortality.
Results:
The following results were observed in the IVT, IVT+CEA, and CEA groups: recanalization rate 17.1%, 77.4%, and 88.5%, resp.; good 3-month clinical outcomes in 56.1%, 74.2%, and 89.8%, resp.; 3-month mortality in 22.0%, 19.4%, and 6.8%, resp. (p<0.05 in all cases for IVT vs. CEA comparison). The use of CEA alone was identified as an independent positive predictor of the achievement of good 3-month clinical outcomes (OR 5.185, 95% CI: 1.973–13.63; p=0.0009), and an independent negative predictor of 3-month mortality (OR 0.295, 95% CI: 0.07112–0.8754; p=0.0329).
Conclusions:
In this retrospective, multicentre study, using an emergent CEA alone in patients with acute ischemic stroke and acute cervical ICA occlusion was associated with a higher recanalization rate and the achievement of good 3-month clinical outcomes and low 3-month mortality.
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