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Dear Editor

Early carotid artery endarterectomy (CEA) following intravenous thrombolysis (IVT) therapy for stroke is thought to be at high haemorrhagic risk by lots of practitioners especially in community hospitals. However, small clinical series have reported the safety of this surgery when applied to carefully selected patients [1, 2].

We have an additional four cases in which early CEA (<15 days) post-IVT was performed. The selection criteria for these patients were the following: thrombolysis for acute ischemic stroke; a cerebral infarct inferior to one-third of the middle cerebral artery territory imaged and a recanalization of middle cerebral artery initially occluded on brain magnetic resonance angiography (MRA); a symptomatic stenosis of 70% or more; and improvement in National Institute of Health Stroke Score (NIHSS) post-IVT.

All four patients were men aged from 53 to 60 years old with no significant disability before stroke. All CEAs were performed under general anesthesia on patients treated with aspirin and intravenous heparin. Patients were free of perioperative complications. At three-months, the modified Rankin Score (mRS) scores were all equal to 1 and no restenoses were documented.

Carotid endarterectomy reduces the risk of stroke in patients with recently symptomatic stenosis. It is also well established that there is a reduction in benefit from CEA with time from the presenting event. Therefore, the procedure should be done early within two-weeks in neurologically stable patients [3, 4].

According to our results and the small data available in the medical literature, surgery of recently symptomatic severe carotid stenosis previously treated by IVT should not be delayed. There seems to be no higher haemorrhagic risk once this surgery is applied to patients with a stable neurological status and good clinical recovery after lysis. As large series of patients will be difficult to collect, it is of interest to report small experiences as ours to try to improve patient care.

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