Artery-Clearing Surgery After Stroke Should Be Delayed
St. Louis, MO - A new study suggests doctors can reduce risks of brain damage after a stroke by delaying a commonly performed follow-up surgery that clears fatty deposits from an artery in the neck. Doctors at Washington University School of Medicine in St. Louis found that the surgery, which reduces risk of additional strokes, should be delayed if patients were recently treated with the clot-busting drug tPA.
“Patients undergoing this surgery a few days after tPA treatment were at higher risk for bleeding complications,” said senior author Greg Zipfel, MD, an associate professor of neurological surgery who treats patients at Barnes-Jewish Hospital. “We think delaying the procedure by at least one week after tPA treatment likely will make the procedure safer and improve patient outcomes.”
The study appears online in the journal Neurosurgery.
After stroke symptoms start, doctors have 4.5 hours to confirm that a stroke is occurring and to give patients tPA to break up the blood clots causing the strokes. (Until recently, the time limit for tPA administration was three hours after stroke onset.)
After the stroke, physicians scan the carotid arteries. If one of these arteries is more than 50 percent blocked with fatty deposits, doctors commonly recommend surgical removal of the plaque a few days after the stroke through a carotid endarterectomy. During this procedure, surgeons open the diseased artery and remove the plaque. This helps reduce the chances that a fragment of the plaque will break free, block a small brain blood vessel and cause another stroke. Continue>
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