Impact of presenting stroke severity and thrombolysis on outcomes following urgent carotid interventions. Article

Full Text via DOI: 10.1016/j.jvs.2023.04.031 PMID: 37330150

Cited authors

  • Hayson, Burton, Allen, Sternbergh, Fort, Bazan


  • BACKGROUND\nMETHODS\nRESULTS\nCONCLUSIONS\nCarotid interventions are increasingly performed in select patients following acute stroke. We aimed to determine the effects of presenting stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and use of systemic thrombolysis (tissue plasminogen activator [tPA]) on discharge neurologic outcomes (modified Rankin scale [mRS]) following urgent carotid endarterectomy (uCEA) and urgent carotid artery stenting (uCAS).\nPatients undergoing uCEA/uCAS at a tertiary Comprehensive Stroke Center (January 2015 to May 2022) were divided into two cohorts: (1) no thrombolysis (uCEA/uCAS only) and (2) use of thrombolysis before the carotid intervention (tPA + uCEA/uCAS). Outcomes were discharge mRS and 30-day complications. Regression models were used to determine an association between tPA use and presenting stroke severity (NIHSS) and discharge neurologic outcomes (mRS).\nTwo hundred thirty-eight patients underwent uCEA/uCAS (uCEA/uCAS only, n=186; tPA + uCEA/uCAS, n=52) over seven years. In the thrombolysis cohort compared to the uCEA/uCAS only cohort, the mean presenting stroke severity was higher (NIHSS = 7.6 vs. 3.8, P = 0.001), and more patients presented with moderate to severe strokes (57.7% vs. 30.2% with NIHSS > 4). The 30-day stroke, death, and myocardial infarction (MI) rates in the uCEA/uCAS only vs. tPA + uCEA/uCAS were 8.1% vs. 11.5% (P = 0.416), 0% vs. 9.6% (P < 0.001), and 0.5% vs. 1.9% (P=0.39), respectively. The 30-day stroke/hemorrhagic conversion and MI rates did not differ with tPA use; however, the difference in deaths was significantly higher in the tPA+uCEA/uCAS cohort (P < 0.001). There was no difference in neurologic functional outcome with or without thrombolysis use (mean mRS = 2.1 vs. 1.7, P = 0.061). For both minor strokes (NIHSS ≤ 4 vs.> 4: relative risk (RR) = 1.58 vs. 1.58, tPA vs. no tPA, respectively, P = 0.997) and moderate strokes (NIHSS ≤ 10 v. > 10: RR = 1.94 vs. 2.08, tPA v.s no tPA, respectively, P = 0.891), the likelihood of discharge functional independence (mRS score ≤ 2) was not influenced by tPA.\nPatients with a higher presenting stroke severity (NIHSS) had worse neurologic functional outcomes (mRS). Patients presenting with minor and moderate strokes were more likely to have discharge neurologic functional independence (mRS ≤ 2), regardless of whether they received tPA or not. Overall, presenting NIHSS is predictive of discharge neurologic functional autonomy and is not influenced by the use of thrombolysis.


Publication date

  • 2023

Published in

International Standard Serial Number (ISSN)

  • 0741-5214