Perioperative microemboli and platelet aggregation in patients undergoing carotid endarterectomy

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Hematology

Background:

• Platelet aggregation remains elevated in carotid endarterectomy (CEA) patients even with heparin. The link between this aggregation and perioperative microemboli is not fully understood.
• Antiplatelet therapies like aspirin and clopidogrel are commonly used in CEA patients, but their impact on intraoperative platelet activity and microemboli requires further investigation.

Purpose of the Study:

• To investigate the correlation between increased platelet aggregation and perioperative microemboli occurrence in CEA patients.
• To evaluate the effect of aspirin and clopidogrel on platelet aggregation and microemboli during CEA.

Main Methods:

• Prospective study of 27 CEA patients, assessing platelet aggregation and P-selectin expression at multiple time points.
• Utilized Transcranial Doppler (TCD) monitoring to quantify perioperative microemboli.
• Compared outcomes between patients receiving aspirin alone versus aspirin with clopidogrel.

Main Results:

• Platelet aggregation significantly increased post-heparinization in both aspirin and clopidogrel groups (p < .01 and p < .05).
• A trend towards increased P-selectin expression was observed post-heparinization.
• Patients on clopidogrel exhibited significantly fewer microemboli compared to those on aspirin alone (4.1 +/- 2.3 vs 17.6 +/- 18.2; p < .01).
• Higher baseline platelet aggregation showed a tendency towards increased microemboli (p = .08).

Conclusions:

• Platelet aggregation transiently increases during CEA, even with antiplatelet agents.
• Clopidogrel use is associated with a reduction in perioperative microemboli during CEA.
• Further research is needed to clarify the relationship between these findings and the risk of thromboembolic complications post-CEA.