Emergency Carotid Endarterectomy Instead of Carotid Artery Stenting Reduces Delayed Hemorrhage in Thrombectomy Stroke Pa
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ORIGINAL ARTICLE
Emergency Carotid Endarterectomy Instead of Carotid Artery Stenting Reduces Delayed Hemorrhage in Thrombectomy Stroke Patients Raveena Singh1 · Sven Dekeyzer1 · Arno Reich2 Martin Wiesmann1 · Omid Nikoubashman1
· Drosos Kotelis3 · Alexander Gombert3 ·
Received: 2 July 2020 / Accepted: 13 August 2020 © The Author(s) 2020
Abstract Purpose Data in the literature suggest that thrombectomy with emergency carotid artery stenting (CAS) in acute stroke is associated with an increased hemorrhage rate. As we perform thrombectomy with the patient under general anesthesia, we avoid emergency CAS and perform emergency carotid endarterectomy (CEA) as an alternative to CAS in the same anesthesia session in our angiography suite whenever needed and possible. Methods We compared 27 thrombectomy patients with emergency CEA and 62 thrombectomy patients with emergency CAS and glycoprotein (Gp) IIb/IIIa inhibitors and/or dual antiplatelet therapy (DAPT) in the same time span. Results The symptomatic hemorrhage rate was 0% (0/27) in the CEA group and 8% (5/62) in the CAS group (p = 0.317). The parenchymal hemorrhage rate (PH2) was 7% (2/27) in the CEA group and 16% (10/62) in the CAS group (p = 0.333). Both cases of PH2 in the CEA group occurred during the intervention and were diagnosed on immediate postinterventional imaging, whereas in the CAS group only 2/10 cases of PH2 occurred during the intervention and the remaining 8 PH2 occurred within 3 days after the intervention (p = 0.048). Clinical outcome at 90 days was comparable with 39% of CEA and 51% of CAS patients achieving good clinical outcome (modified Rankin scale, mRS 0–2, p = 0.452). Conclusion The use of CEA is a feasible alternative to CAS in acute stroke and has the advantage that DAPT/GpIIb/IIIa inhibitors are not needed. All PH2 in CEA patients occurred during the intervention, implying that hemorrhage in this group is likely to be caused by reperfusion injury, whereas delayed hemorrhage is likely to be caused by DAPT/GpIIb/IIIa inhibitors.
Keywords Stroke · Thrombectomy · Carotid endarterectomy · Carotid stenting · Hemorrhage
Introduction
Availability of data and material: further data that support the findings of this study are available from the corresponding author upon reasonable request. Code availability: IBM Statistics SPSS 25. Omid Nikoubashman
[email protected] 1
Department of Neuroradiology, University Hospital RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
2
Department of Neurology, University Hospital RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
3
Department of Vascular Surgery, University Hospital RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Stroke is one of the most common causes of disability and death worldwide. Endovascular stroke treatment allows for treatment of patients with large vessel occlusion stroke [1, 2]. Approximately 20% of ischemic strokes are due to atherosclerotic carotid artery stenosis and approximately 6% of patients who receive endovascular stro
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