Antiplatelet treatment after carotid endarterectomy: a pilot study

The present study was undertaken in patients subjected to endarterectomy for extracranial carotid stenosis in order to verify the efficacy and the safety of medical treatment with indobufen (2-[4-(1-oxo-2-isoindolinyl)-phenyl] butyric acid), a drug which has been successfully used in the long-term treatment of cardiovascular ischemic diseases, and which showed a significant antiplatelet effect. One hundred thirty-eight patients entered into the study with previous diagnosis of cerebrovascular ischemic event within 3 months before surgery. Patients were treated after surgery with indobufen 400 mg/die/orally in the first 2 months after discharge and than 200 mg/die/orally. The planned duration of medical treatment was 24 months. Any patient interrupting the medical treatment for a cumulative period greater than 30 days/year was excluded from the analysis; the end points of the study were considered death and the occurrence of disabling stroke. Eleven patients were considered as dropped out because of treatment interruption. The operative (at 1 month after surgery) mortality rate was 0.79%. The cumulative operative mortality and morbidity rate was estimated in 2.37%. The mean follow-up period was 6 months and the cumulative mortality rate at 36 months was estimated in 7.14%. The cumulative risk/year of TIA or ischemic stroke is higher than the risk for myocardial infarction, but the long-term mortality rate mainly depends on the latter complication which occurred later. Treatment with indobufen after carotid surgery seems to be effective as far it was restricted to an homogeneous group of patients presenting symptomatic extracranial carotid disease.