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Performing carotid endarterectomy or stenting in patients who were recently treated with thrombolytic therapy for an acute stroke appeared to be safe, an observational study showed.

Among patients who underwent an endovascular procedure for symptomatic carotid artery stenosis, previously receiving recombinant tissue plasminogen activator (tPA) (2.5% versus 3.8%, P=0.55), according to , of Karolinska University Hospital in Stockholm, and colleagues.

The rate of bleeding requiring re-operation was not significantly different between those who did and those who did not previously receive thrombolysis for an acute stroke (3.8% versus 3.3%, P=0.79), the researchers reported in the March issue of Stroke: Journal of the American Heart Association.

However, some limitations of their study -- including the small patient numbers, the retrospective design, and the use of registry data -- precluded drawing any definitive conclusions.

"It is, therefore, of utmost importance that centers continue to prospectively record their outcomes after these procedures to investigate further the safety of undertaking carotid procedures after systemic thrombolysis for stroke," Wahlgren and colleagues wrote.

"The efficacy of such procedures in the prevention of further ischemic insults must also be evaluated, and we urge others to prospectively record death and stroke rates for patients with a significant (50% to 99%) ipsilateral carotid stenosis undergoing thrombolysis but who do not, for whatever reasons, proceed to surgery or stenting and are managed with medical therapy alone."

Despite the uncertain benefits of emergent carotid endarterectomy and other operations for patients with acute ischemic stroke -- as highlighted in guidelines from the American Heart Association and American Stroke Association last year -- some centers have moved toward earlier use of endarterectomy. At the same time, the use of thrombolysis in the acute setting has grown, increasing the number of patients who undergo a carotid revascularization procedure after receiving tPA.

There is little information available, however, regarding whether the prior use of thrombolytics is associated with greater risks during the procedures.

To explore the issue, Wahlgren and colleagues looked at data from Swedish national registries on 3,998 patients who underwent either carotid endarterectomy or carotid stenting for symptomatic carotid stenosis from May 2008 through December 2012.

Of those patients, 2% had received tPA for stroke at some point before their procedure. The median interval was 10 days, with a range from 0 to 108 days.

Rates of serious complications did not differ between those who did not have previous exposure to thrombolytic therapy and those who did. There were no cerebral hemorrhages, cranial nerve injuries, or cardiac events through 30 days -- and no deaths through 2 years -- in the patients who had previously received tPA.

All five of the patients in the thrombolysis cohort who had serious complications within 30 days -- including three with reoperation for bleeding, one with a retinal infarction, and one with a minor stroke -- underwent carotid endarterectomy within 1 week of receiving tPA.

"However, the number of patients is small and is not sufficient for any firm conclusions to be made about the optimal time frame during which to offer endarterectomy/stenting after thrombolysis," the authors wrote.

They added that the study cannot be used to determine whether endarterectomy or stenting would be better following tPA administration because only six patients underwent the latter procedure in the thrombolysis group.

From the American Heart Association:

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