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Dextran reduces embolic signals after carotid endarterectomy
C R Levi1, J L Stork, B R Chambers
1Department of Neurology, John Hunter Hospital, Newcastle, Australia.
Insights
Dextran 40 administration during carotid endarterectomy (CEA) significantly reduced postoperative embolic signals detected by transcranial Doppler. This suggests dextran may offer neuroprotection by decreasing embolic events following CEA.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Pharmacology
Background:
- Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
- Embolic signals detected post-CEA can indicate a risk of stroke.
Purpose of the Study:
- To evaluate the effect of 10% dextran 40 on reducing embolic signals after CEA.
Main Methods:
- 150 patients undergoing CEA were randomized to receive intravenous 10% dextran 40 or placebo.
- Transcranial Doppler monitoring of the middle cerebral artery was performed postoperatively.
Main Results:
- Embolic signals were detected in 57% of placebo vs. 42% of dextran patients within 1 hour post-op (p=0.052).
- Embolic signal counts were 46% lower in the dextran group within 1 hour.
- Between 2-3 hours post-op, embolic signals were present in 45% of placebo vs. 27% of dextran patients (p=0.040).
- Embolic signal counts were 64% lower in the dextran group at 2-3 hours.
Conclusions:
- Intravenous 10% dextran 40 reduces embolic signals within 3 hours after carotid endarterectomy.
- Dextran may play a role in neuroprotection by mitigating embolic events post-CEA.
Abstract:
One hundred fifty patients undergoing carotid endarterectomy were randomly assigned to receive intravenous 10% dextran 40 or placebo. Transcranial Doppler monitoring of the ipsilateral middle cerebral artery 0 to 1 hour postoperatively detected embolic signals in 57% of placebo and 42% of dextran patients, with overall embolic signal counts 46% less for dextran (p = 0.052). Two to 3 hours postoperatively, embolic signals were present in 45% of placebo and 27% of dextran patients, with embolic signal counts 64% less for dextran (p = 0.040). We conclude that dextran reduces embolic signals within 3 hours of CEA.
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