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Urgent carotid intervention is safe after thrombolysis for minor to moderate acute ischemic stroke  Hernan A. Bazan, MD, FACS, Nicolas Zea, MD, Bethany.

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Presentation on theme: "Urgent carotid intervention is safe after thrombolysis for minor to moderate acute ischemic stroke  Hernan A. Bazan, MD, FACS, Nicolas Zea, MD, Bethany."— Presentation transcript:

1 Urgent carotid intervention is safe after thrombolysis for minor to moderate acute ischemic stroke 
Hernan A. Bazan, MD, FACS, Nicolas Zea, MD, Bethany Jennings, RN, Taylor A. Smith, MD, FACS, Gabriel Vidal, MD, W. Charles Sternbergh, MD, FACS  Journal of Vascular Surgery  Volume 62, Issue 6, Pages (December 2015) DOI: /j.jvs Copyright © 2015 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Breakdown of carotid patients selected for this analysis. CAS, Carotid artery stenting; CEA, carotid endarterectomy; TIA, transient ischemic attack; uCAS, urgent/index admission-performed CAS; uCEA, urgent/index admission-performed CEA. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Timing to carotid intervention after an acute neurologic symptom onset. tPA, Tissue plasminogen activator; uCAS, urgent/index admission-performed carotid artery stenting; uCEA, urgent/index admission-performed carotid endarterectomy. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Detailed data set of the cohorts highlighting the 30-day complications and stroke severity. A, Intracerebral hemorrhage (ICH) in patients receiving tissue plasminogen activator (tPA). B, ICH in patients not receiving tPA. A dashed line denotes a moderate stroke with a National Institutes of Health Stroke Scale (NIHSS) score of 10. Each dot represents a unique patient for each cohort: red dot, occurrence of an ICH event; black dot, no ICH occurred. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Computed tomography (CT) brain perfusion scans demonstrating core infarcts and an ischemic penumbra. A, Matched defect on CT perfusion scan demonstrating a large core infarct in the left posterior middle cerebral artery territory. There is no need to do an urgent CEA or CAS. This CT perfusion scan shows a matched defect with decreased cerebral blood flow (CBF) and poor cerebral blood volume (CBV), typical of core infarct. Top left, CBF is decreased (purple area). Top right, CBV is also decreased (blue/purple area). Bottom left, Mean transit time is elevated (red/yellow area). Bottom right, Time to peak is also elevated (red/yellow area). Right image, Magnetic resonance imaging (MRI)/diffusion-weighted imaging demonstrates an infarcted tissue corresponding to the territory with matched defect on CT perfusion. B, An ischemic penumbra is identified in the left hemisphere. Left image, CT perfusion map shows a left middle cerebral artery stroke, but there is a mismatch between CBF and CBV. Top left, CBF is decreased (purple area). Top right, CBV is normal or the same on both hemispheres. Bottom left, Mean transit time is elevated (red/yellow area). Bottom right, Time to peak is elevated (red/yellow area). Right image, MRI/diffusion-weighted imaging—small watershed infarcts in the left middle cerebral artery territory corresponding to the territory on the CT perfusion scan. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

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