title: Urgent carotid surgery and stenting may be safe after systemic thrombolysis for stroke.
abstract: OBJECTIVE
  Early carotid surgery or stenting after thrombolytic treatment for stroke has become more common during recent years. It is unclear whether this carries an increased risk of postoperative complications and death. The aim of this nationwide population-based study was, therefore, to investigate the safety of urgently performed carotid procedures in patients treated with thrombolysis for stroke.
  
  
  METHODS
  Using the national Vascular and Stroke registries, we identified 3998 patients who had undergone carotid endarterectomy or carotid artery stenting for symptomatic carotid stenosis between May 2008 and December 2012. Among these, 2% (79 of 3998) had undergone previous thrombolysis for stroke. We conducted a retrospective review of registry data and individual case records with regard to postoperative complications, including surgical-site bleeding, stroke, and death. The outcome was compared with the results for the remaining patient cohort (3919 of 3998) undergoing carotid surgery and stenting during the study period.
  
  
  RESULTS
  The median time between thrombolysis and the carotid procedure was 10 days. Seventy-one patients underwent carotid endarterectomy, and 6 patients underwent carotid artery stenting. The 30-day death and stroke rate for the thrombolysis cohort was 2.5% (2 of 79), and for the whole cohort, it was 3.8% (139 of 3626; P=0.55). The postoperative bleeding rates requiring reoperation were not significantly different between the groups (3.8% [3 of 79] in the thrombolysis group versus 3.3% [119 of 3626] in the whole cohort; P=0.79). There was no correlation between time from lysis to surgery or stenting and complications at 30 days postoperatively.
  
  
  CONCLUSIONS
  Urgent carotid endarterectomy or carotid artery stenting after thrombolysis for stroke may be safe without increased risk of serious complications.
authors: From the Department of Vascular Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden (L.K.-S., C.-M.W.); Department of Surgery, Blekinge Hospital, Karlskrona, Sweden (T.T.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (T.T., M.B., B.K.).
authors: Linn
authors: L
authors: Koraen-Smith
authors: Thomas
authors: T
authors: Troëng
authors: Martin
authors: M
authors: Björck
authors: Björn
authors: B
authors: Kragsterman
authors: Carl-Magnus
authors: CM
authors: Wahlgren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D015912:Thrombolytic Therapy
keywords: carotid; endarterectomy; stroke; thrombolytic therapy