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Intraoperative use of dextran is associated with cardiac complications after carotid endarterectomy
Alik Farber1, Tze-Woei Tan, Denis Rybin
1Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, MA, USA. Alik.Farber@bmc.org
Insights
Intraoperative dextran use during carotid endarterectomy (CEA) did not reduce stroke risk but increased risks of myocardial infarction (MI) and congestive heart failure (CHF). Findings suggest limited utility for routine dextran in CEA procedures.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Pharmacology
Background:
- Dextran has been theorized to reduce stroke risk following carotid endarterectomy (CEA).
- However, its actual clinical utility and impact on perioperative outcomes remain debated.
- Variations in dextran usage during CEA necessitate a clear evaluation of its benefits and risks.
Purpose of the Study:
- To evaluate the outcomes associated with intraoperative dextran use in patients undergoing CEA.
- To clarify the clinical utility of dextran in the context of CEA procedures.
- To assess the association between dextran administration and perioperative complications such as stroke, myocardial infarction (MI), and congestive heart failure (CHF).
Main Methods:
- A retrospective study of primary CEAs performed between 2003 and 2010 was conducted using the Vascular Study Group of New England database.
- Patients were stratified based on intraoperative dextran administration.
- Risk-adjusted comparisons were performed using group and propensity score matching, with multivariable logistic and gamma regressions to analyze outcomes.
Main Results:
- A total of 6641 CEAs were analyzed, with dextran used in 5% of cases.
- Dextran use was not associated with a reduced rate of stroke or death (1.2% in both groups).
- Dextran-treated patients showed significantly higher rates of postoperative MI (2.4% vs. 0.5%, P=.003) and CHF (2.1% vs. 0.2%, P<.001) compared to untreated patients.
Conclusions:
- Intraoperative dextran administration during CEA is not associated with a lower risk of perioperative stroke.
- Dextran use was significantly correlated with increased rates of postoperative myocardial infarction and congestive heart failure.
- The findings indicate limited clinical utility for the routine use of intraoperative dextran in patients undergoing carotid endarterectomy.
Objective:
Although dextran has been theorized to diminish the risk of stroke associated with carotid endarterectomy (CEA), variation exists in its use. We evaluated outcomes of dextran use in patients undergoing CEA to clarify its utility.
Methods:
We studied all primary CEAs performed by 89 surgeons within the Vascular Study Group of New England database (2003-2010). Patients were stratified by intraoperative dextran use. Outcomes included perioperative death, stroke, myocardial infarction (MI), and congestive heart failure (CHF). Group and propensity score matching was performed for risk-adjusted comparisons, and multivariable logistic and gamma regressions were used to examine associations between dextran use and outcomes.
Results:
There were 6641 CEAs performed, with dextran used in 334 procedures (5%). Dextran-treated and untreated patients were similar in age (70 years) and symptomatic status (25%). Clinical differences between the cohorts were eliminated by statistical adjustment. In crude, group-matched, and propensity-matched analyses, the stroke/death rate was similar for the two cohorts (1.2%). Dextran-treated patients were more likely to suffer postoperative MI (crude: 2.4% vs 1.0%; P = .03; group-matched: 2.4% vs 0.6%; P = .01; propensity-matched: 2.4% vs 0.5%; P = .003) and CHF (2.1% vs 0.6%; P = .01; 2.1% vs 0.5%; P = .01; 2.1% vs 0.2%; P < .001). In multivariable analysis of the crude sample, dextran was associated with a higher risk of postoperative MI (odds ratio, 3.52; 95% confidence interval, 1.62-7.64) and CHF (odds ratio, 5.71; 95% confidence interval, 2.35-13.89).
Conclusions:
Dextran use was not associated with lower perioperative stroke but was associated with higher rates of MI and CHF. Taken together, our findings suggest limited clinical utility for routine use of intraoperative dextran during CEA.
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