| Carotid endarterectomy performed in the morning is associated with increased cerebral microembolization. | |
| | |
MedLine Citation:
|
PMID: 19223147 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVES: Platelet function exhibits circadian variation with highest levels of activity in the morning and plays a central role in arterial thrombotic events, including thrombotic stroke following carotid endarterectomy (CEA). Prior to the platelet-rich thrombus occluding the carotid artery, multiple embolic signals are detected in the middle cerebral artery using transcranial Doppler ultrasound. We hypothesized that patients undergoing CEA early in the day may be at an increased stroke risk and this would manifest as an increased postoperative embolic count. METHODS: Data were collected prospectively on 235 patients undergoing primary CEA. Accurate start and finish times were recorded in addition to the number of postoperative emboli detected in the first three hours after CEA using transcranial Doppler (TCD) monitoring. RESULTS: For operations finishing before midday, there was a 3.6-fold increase in the number of emboli detected relative to afternoon finishes (53.2 vs 14.8, P = .002) with similar results for starts before 10:30 AM (48.1 vs 14.7, P =.002). There was also a significant correlation between start time and emboli count (P = .02). Of the 55 patients with no postoperative emboli, only 19 had a morning start (relative risk 0.63, P = .011). Patients were 6.9 times more likely to require treatment with Dextran-40 to prevent progression onto a thrombotic stroke if their CEA finished before midday (P = .008). CONCLUSION: There is a significantly increased rate of postoperative embolization for operations begun earlier in the day. Carotid endarterectomies performed in the afternoon may be at less risk of developing postoperative thrombotic stroke. |
| | |
Authors:
|
David Bowden; Natalie Hayes; Nicholas London; Peter Bell; A Ross Naylor; Paul Hayes |
Related Documents
:
|
1987677 - Recurrent transient ischemic attacks and stroke in association with an internal carotid... 11259967 - The inter-sonographer reliability of carotid duplex ultrasound. 1509617 - Ultrasound doppler spectral analysis in the diagnosis of occlusive lesions of the carot... 15731477 - Derivation of transcranial doppler criteria for rescue intra-arterial thrombolysis: mul... 15353867 - Procedural results and distal embolization after saphenous vein graft stenting and angi... 10443527 - Radical resection of a pulmonary blastoma involving the mediastinum. |
Publication Detail:
|
Type: Journal Article Date: 2009-02-15 |
Journal Detail:
|
Title: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter Volume: 50 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2009 Jul |
Date Detail:
|
Created Date: 2009-06-30 Completed Date: 2009-07-09 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 48-53 Citation Subset: IM |
Affiliation:
|
Addenbrooke's Hospital, Cambridge, United Kingdom. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Cerebrovascular Circulation Circadian Rhythm Endarterectomy, Carotid / adverse effects* Humans Intracranial Embolism / etiology*, physiopathology, ultrasonography Middle Cerebral Artery / ultrasonography Platelet Activation / physiology Ultrasonography, Doppler, Transcranial |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Initial experience characterizing a type I endoleak from velocity profiles using time-resolved three...
Next Document: Silent embolic infarcts on computed tomography brain scans and risk of ipsilateral hemispheric event...