Carotid endarterectomy and intracranial thrombolysis: Simultaneous and staged procedures in ischemic stroke

Abstract

Combining carotid surgery with thrombolysis (simultaneous or staged procedure) offers a new therapeutic approach in the emergency management of an acute carotid-related stroke. Its efficacy should be evaluated in interdisciplinary studies.

Guidelines for the Early Management of Adults With Ischemic Stroke

“…However, some surgeons report encouraging results from emergency operations for patients with severe stenosis or occlusion of the internal carotid artery existing for Յ24 hours. 324,386,[451][452][453][454][455][456][457][458][459][460] In general, improvement after surgery was found among patients with mild to moderate neurological impairments. Still, the data are limited, and the usefulness of urgent surgery among patients with severe neurological deficits is even less clear.…”

Recanalization of acute symptomatic occlusions of the internal carotid artery

“…Recanalization rates with thrombolytic therapy are dependent on the size of the occluded vessel and the presence of collateral blood flow, as the rates are higher in smaller arteries and in the presence of good collateral blood flow [19]. The benefits of acute embolectomy, intraarterial thrombolysis, the combination of both or angioplasty in this life threatening condition of ICA occlusion are still under investigation [8,26]. Our study shows that CCDS is an appropriate non-invasive tool to identify and monitor those individuals that may benefit from these therapies.…”

Update on Ultrasound Techniques for the Diagnosis of Cerebral Ischemia

“…A rapid test for the detection and quantification of the severity of arterial patency and brain perfusion in acute ischemic stroke can be used in patient selection for reperfusion therapies, invasive angiography, urgent interventional treatment [1,2,3], and for assessing short- and long-term prognosis [4,5,6,7]. Computed tomography angiography (CTA) and magnetic resonance angiography are noninvasive imaging techniques capable of assessing vessel obstruction in acute stroke [8, 9].…”