Objective

The aim of this study was to evaluate the effect of pre-operative intravenous thrombolytic therapy (ivTT) on short term outcomes after carotid endarterectomy (CEA) among patients who presented with ischaemic stroke.

Methods

A retrospective study using a large population based dataset from the National Vascular Registry in the United Kingdom (UK-NVR). The cohort included adult patients who underwent CEA for ischaemic stroke between 1 January 2014 and 31 December 2019. NVR records provided information on patient demographics, Rankin score, medication, time from onset of symptoms to surgery and whether the patient received ivTT prior to surgery. Logistic regression was used to evaluate the relationship between ivTT and rates of any stroke at 30 days after CEA and in hospital complication rates for neck haematoma. Secondary outcomes included in hospital cardiac and respiratory complications, and cranial nerve injury.

Results

Between 2014 and 2019, 9 030 patients presented with a stroke and underwent CEA, of whom 1 055 (11.7%) had received pre-operative ivTT. Those receiving ivTT were younger (mean 70.6 vs. 72.0 years, p < .001). The median (IQR) time from symptom to CEA was 10 days (6 – 17) for ivTT patients and 11 days (7 – 20) for CEA patients not receiving ivTT. Post-operative rates of 30 day stroke were similar between the no ivTT (2.1%) and ivTT (1.8%) cohorts (p = .48). In hospital neck haematomas were statistically significantly more common in CEA patients receiving ivTT (3.7%) vs. no ivTT (2.3%) (p = .006). There was no statistically significant association between 30 day stroke and neck haematoma complications when stratified for delays from symptom onset to CEA, but the overall cohort contained few adverse events for analysis during the very early time period.

Conclusion

The use of ivTT before CEA in stroke patients was not associated with an increased risk of 30 day stroke, but there was an increase in the risk of neck haematoma.

中文翻译：

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英国静脉溶栓后颈动脉内膜切除术

目标

本研究的目的是评估术前静脉溶栓治疗 (ivTT) 对缺血性卒中患者颈动脉内膜切除术 (CEA) 后短期预后的影响。

方法

一项使用来自英国国家血管登记处 (UK-NVR) 的大型人群数据集的回顾性研究。该队列包括在 2014 年 1 月 1 日至 2019 年 12 月 31 日期间因缺血性卒中接受 CEA 的成年患者。 NVR 记录提供了有关患者人口统计学、Rankin 评分、药物治疗、从症状出现到手术的时间以及患者在手术前是否接受 ivTT 的信息。Logistic 回归用于评估 ivTT 与 CEA 后 30 天中风发生率和颈部血肿住院并发症发生率之间的关系。次要结果包括医院心脏和呼吸系统并发症以及颅神经损伤。

结果

2014 年至 2019 年间，9 030 名卒中患者接受了 CEA，其中 1 055 名（11.7%）接受了术前 ivTT。接受 ivTT 的人更年轻（平均 70.6岁与72.0 岁，p < .001）。ivTT 患者从出现症状到 CEA 的中位 (IQR) 时间为 10 天（6-17），未接受 ivTT 的 CEA 患者为 11 天（7-20）。无 ivTT (2.1%) 和 ivTT (1.8%) 队列的术后 30 天卒中发生率相似 ( p  = .48)。在接受 ivTT (3.7%)与未接受 ivTT (2.3%) 的CEA 患者中，医院颈部血肿在统计学上显着更常见（p = .006）。当根据从症状出现到 CEA 的延迟进行分层时，30 天中风与颈部血肿并发症之间没有统计学上的显着关联，但整个队列在非常早期的时间段内几乎没有不良事件可供分析。

结论

卒中患者在 CEA 前使用 ivTT 与 30 天卒中风险增加无关，但颈部血肿风险增加。