Risk of stroke recurrence after intravenous thrombolysis in patients with symptomatic carotid stenosis

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Nordanstig, Annika,1974Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden (author)

Risk of stroke recurrence after intravenous thrombolysis in patients with symptomatic carotid stenosis

Article/chapterEnglish2023

Publisher, publication year, extent ...

Cambridge University Press,2023

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LIBRIS-ID:oai:gup.ub.gu.se/337039
https://gup.ub.gu.se/publication/337039URI
https://doi.org/10.1017/cjn.2023.284DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-214694URI
http://kipublications.ki.se/Default.aspx?queryparsed=id:153838858URI

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Language:English

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Subject category:art swepub-publicationtype

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Objective: To assess if intravenous thrombolysis (IVT) affects the risk of recurrent preoperative cerebrovascular events before carotid surgery or stenting in patients with symptomatic ≥ 50% carotid stenosis. Methods: Three cohorts of symptomatic ≥ 50% carotid stenosis patients were merged. To make the control group relevant, we excluded patients not presenting with stroke on the day of symptom onset. The risk of preoperative cerebrovascular events up to 30 days were compared between the IVT-treated and non-IVT-treated. Results: 316 patients were included, 64 (20%) treated with IVT. Those treated with IVT had similar risk of recurrent ipsilateral ischemic stroke or retinal artery occlusion (12% at day 7, 12% at day 30) as those not treated (9% at day 7, 15% at day 30; adjusted HR 0.9, 95%CI 0.4-2.2). There was a tendency (p=0.09) towards time-dependency in the data where the recurrence risk was higher in IVT treated at day 0 (6% in IVT-treated, 1% in non-IVT-treated, OR 5.5, 95%CI 1.2-25.4, p=0.03). This was not significant when adjusting for co-factors (adjusted OR 4.4, 95%CI 0.9-21.8, p=0.07) and was offset by a later risk decrease, with no remaining risk difference between IVT-treated and non-IVT treated at day 7. Conclusions: IVT treatment does not seem to affect the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic ≥ 50% carotid stenosis: The risk is high in both IVT-treated and non-IVT-treated. However, there might be a risk increase on the day of IVT treatment that is offset by a risk decrease during the first week.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Medicinska och farmaceutiska grundvetenskaper Neurovetenskaper hsv//swe
MEDICAL AND HEALTH SCIENCES Basic Medicine Neurosciences hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Neurologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Neurology hsv//eng
Carotid stenosis
Intravenous thrombolysis
Risk
Stroke
Carotid stenosis

Added entries (persons, corporate bodies, meetings, titles ...)

Gu, ThomasUmeå universitet,Neurovetenskaper(Swepub:umu)thgu0006 (author)
Henze, AlexanderUmeå universitet,Diagnostisk radiologi(Swepub:umu)alhe0084 (author)
Wester, Per,1959-Umeå universitet,Institutionen för folkhälsa och klinisk medicin,Department of Clinical Sciences, Danderyds Hospital Karolinska Institute, Stockholm, Sweden(Swepub:umu)pewe0002 (author)
Fox, Allan J.Sunnybrook Health Science Center, Department of Medical Imaging, University of Toronto, ON, Toronto, Canada (author)
Johansson, Elias,1984Umeå universitet,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience,Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM),Neurovetenskaper,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden(Swepub:umu)elsjon02 (author)
Göteborgs universitetInstitutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap (creator_code:org_t)

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In:Canadian Journal of Neurological Sciences: Cambridge University Press0317-1671

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