Dextran as an Adjunct in Carotid Endarterectomy: A Systematic Review and Meta-Analysis
Duarte Silva-Vieira1, António Pereira-Neves2, Hipolito Nzwalo3
1Faculty of Medicine of the University of Porto, Porto, Portugal.
Annals of Vascular Surgery
|June 29, 2025
Summary
Dextran use in carotid endarterectomy (CEA) showed a low stroke incidence (0.7%) post-surgery. Further trials are needed to confirm efficacy and safety due to study heterogeneity and potential risks.
Area of Science:
- Vascular Surgery
- Pharmacology
- Evidence-Based Medicine
Background:
- Carotid endarterectomy (CEA) is a key stroke prevention surgery for carotid artery stenosis.
- Dextran, an antithrombotic agent, is explored for reducing complications during CEA.
- Its efficacy and safety in this context remain debated.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of thromboembolic and hemorrhagic complications.
- To assess the safety and efficacy of dextran as an adjunctive therapy in CEA patients.
Main Methods:
- Systematic literature search across major databases (MEDLINE, Scopus, Web of Science).
- Random-effects meta-analysis to pool adverse event incidence.
- Quality assessment using NHLBI and Cochrane tools; heterogeneity assessed via meta-regression.
Main Results:
- Ten studies (149,540 patients) were included; predominantly observational with one RCT.
- Pooled incidence of stroke post-CEA with dextran was 0.7% (95% CI: 0.3-1.1%), showing moderate heterogeneity.
- Geographic region was a significant source of heterogeneity; dextran often used selectively in high-risk patients.
Conclusions:
- Dextran use in CEA is linked to a low incidence of thromboembolic events.
- Heterogeneity necessitates further large-scale RCTs for definitive efficacy and safety data.
- Individualized patient selection and standardized protocols are crucial due to potential risks like hemorrhage and renal issues.
