University thesis:
Dissertation, Universitätsmedizin der Universität Greifswald, 2021
Footnote:
Literaturverzeichnis: Seite 59-72
Text deutsch, Anhang teilweise englisch
Description:
Schlaganfall, ACI, IVT, CEA, stroke
Introduction: Intravenous thrombolysis (IVT) in combination with endarterectomy of the carotid (CEA) is increasingly used as a therapeutic option for patients after an acute stroke. However, there are concerns with such combination therapy about an increased of intra- and extracranial bleeding, postoperative strokes or even a fatal course. However, the morbidity and mortality of this sequential combination therapy have so far only been analyzed in small case groups and should therefore now be checked on our own patient population. Material and methods: From July 1st 2005 to December 31st 2016, 530 patients with stenoses of the internal carotid artery (ACI), NASCET> 50%, were operated in one hospital. Symptomatic patients (n = 211) were matched and divided into two comparable groups: the patients in group I (n = 14) received an CEA after IVT with rt-PA. In group II (n = 76) the patients were operated primarily. The time between IVT and CEA in group I was between two and 14 days and in group II from the day of the index event to a maximum of 14 days thereafter. A specialist neurological examination was carried out preoperatively and postoperatively in all patients. Results: The perioperative death rate was 7.1% (1/14) in group I and 1.3% (1/76) in group II. The combined perioperative stroke death rate in group I was 7.1% (1/14) vs. 10.5% (8/76) in group II. There were no neurologically-related deaths in the total collective. In group I, one patient suffered from limited ...