title: Carotid endarterectomy after intravenous thrombolysis for acute cerebral ischaemic attack: is it safe?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  This was a retrospective study. Data including 30 days' follow-up were obtained from medical records and from a vascular registry.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. lisbetknudsenrathenborg@regionh.dk
authors.forename: L K
authors.initials: LK
authors.lastname: Rathenborg
authors.forename: L P
authors.initials: LP
authors.lastname: Jensen
authors.forename: N
authors.initials: N
authors.lastname: Baekgaard
authors.forename: T V
authors.initials: TV
authors.lastname: Schroeder
mesh_terms: D000208:Acute Disease; D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents