Safety of carotid endarterectomy following thrombolysis for acute ischemic stroke

Background: The timing of carotid endarterectomy (CEA) following thrombolysis for acute ischemic stroke remains controversial. We have described our unit's experience and performed a systematic review and pooled data synthesis of the safety of CEA in this group of patients. Methods: Retrospective analysis of patients who had undergone CEA following thrombolysis between 2010 and 2012 was performed. A systematic review of the literature was also performed using PUBMED, EMBASE, and major conference proceedings. The primary outcome measure was 30-day postoperative intracerebral hemorrhage (ICH) and ischemic stroke. The secondary outcome measures were 30-day postoperative all-cause morbidity and mortality. Results: Seven patients underwent CEA following thrombolysis with mean age +/- standard deviation of 70.57 +/- 7.57. Five were men and five had CEA under local anesthesia. CEA was performed in median of 7 days (range, 2-12) after onset of stroke. Thirty-day morbidity was 14% (1/7) with one patient who experienced ICH postoperatively. There was no mortality. Nine studies were identified for systemic review. Seventy patients were included in the pooled data synthesis. One patient (1%) experienced postoperative ICH. When our series was included, the 30-day postoperative ICH was 3% (2/77). The overall 30-day postoperative morbidity was 4% (3/77), and there was no mortality. Conclusions: Despite slightly higher rates of postoperative hemorrhagic strokes than those in randomized trials, CEA appears safe following thrombolysis for acute ischemic stroke. However, more data on the timing of surgery is needed.