Thromboembolic events represent the most common ischemic mechanism in acute ischemic stroke after carotid endarterectomy (CEA), according to findings from a small retrospective study reported in Vascular and Endovascular Surgery.
Investigators reviewed consecutive patients at Nice University Hospital who developed acute ischemic stroke after CEA (n=19). The researchers analyzed magnetic resonance imaging data sets to determine and characterize lesion patterns.
Territorial infarction was reported in 57.9% (n=11) of patients, and an internal watershed infarction, mixed border zone infarction, or cortical watershed infarction was observed in 42.1% (n=8) of patients. According to imaging data, embolic mechanism of stroke was the most frequent vascular mechanism involved in the development of stroke (63.2%; n=12).
Hemodynamic and mixed mechanisms were reported in 10.5% (n=2) and 26.3% (n=5) of patients. Two patients with embolic stroke were able to undergo a successful mechanical thrombectomy with stent retriever devices. In patients with hemodynamic and mixed stroke, the researchers observed an asymmetry of the middle cerebral artery in 60% and 50% of patients, respectively. An asymmetry of the MCA was also observed in 25% of patients with embolic stroke.
The retrospective design represented this study’s main limitation, and the investigators suggest a multicenter design may provide better predictive vascular mechanism factors for post-CEA ischemic stroke.
According to the researchers, an approach involving interventional radiologists, neurologists, and vascular surgeons “would allow [us] to early identify and characterize vascular mechanisms involved in ischemic stroke post CEA and would be of interest to choose the most appropriate therapeutic option.”
Lareyre F, Raffort J, Weill C, et al. Patterns of acute ischemic strokes after carotid endarterectomy and therapeutic implications. Vasc Endovascular Surg. 2017;51(7):485-490.