Document Detail

Prevention of postoperative thrombotic stroke after carotid endarterectomy: the role of transcranial Doppler ultrasound.
MedLine Citation:
PMID:  9357457     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To determine the incidence of particulate embolization after carotid endarterectomy (CEA), the effect of dextran-40 infusion in patients with sustained postoperative embolization, and the impact of transcranial Doppler (TCD) monitoring plus adjuvant dextran therapy on the rate of postoperative carotid thrombosis.
METHODS: Prospective study in 100 patients who underwent CEA with 6-hour postoperative monitoring using a TCD that was modified to allow automatic, intermittent recording from the ipsilateral middle cerebral artery waveform (10 minute sample every 30 minutes). An incremental dextran-40 infusion was commenced if 25 or more emboli were detected in any 10-minute period.
RESULTS: Overall, 48% of patients had one or more emboli detected in the postoperative period, particularly in the first 2 hours. However, sustained embolization that required Dextran therapy developed in only five patients. In each case, the rate of embolization rapidly diminished.
CONCLUSIONS: A small proportion of patients have sustained embolization after CEA, which in previous studies has been shown to be highly predictive of thrombotic stroke. Intervention with dextran reduced and subsequently stopped all the emboli in those in whom it was used and contributed to a 0% perioperative morbidity and mortality rate in this series.
N Lennard; J Smith; J Dumville; R Abbott; D H Evans; N J London; P R Bell; A R Naylor
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  26     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1997 Oct 
Date Detail:
Created Date:  1997-11-25     Completed Date:  1997-11-25     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  579-84     Citation Subset:  IM    
Department of Vascular Surgery, Leicester Royal Infirmary, United Kingdom.
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MeSH Terms
Aged, 80 and over
Anticoagulants / administration & dosage
Cerebral Arteries / ultrasonography
Dextrans / administration & dosage
Endarterectomy, Carotid / adverse effects*
Intracranial Embolism and Thrombosis / etiology,  prevention & control*,  ultrasonography
Middle Aged
Monitoring, Physiologic
Postoperative Period
Prospective Studies
Ultrasonography, Doppler, Transcranial*
Reg. No./Substance:
0/Anticoagulants; 9004-54-0/Dextrans

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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