Transcranial Doppler directed dextran therapy in the prevention of carotid thrombosis: three hour monitoring is as effective as six hours.

Abstract

BACKGROUND:

Six hours' monitoring by transcranial Doppler (TCD) has been successful in directing Dextran therapy in patients at high risk of thrombotic stroke after carotid endarterectomy (CEA).

OBJECTIVES:

Is 3 h of routine monitoring as effective as 6 h in the prevention of early postoperative thrombotic stroke?

DESIGN:

Prospective, consecutive study in all patients with an accessible cranial window.

METHODS:

One hundred and sixty-six patients undergoing CEA underwent 3 h of postoperative monitoring by TCD. Any patient with > 25 emboli detected in any 10 min period or those with emboli that distorted the arterial waveform were commenced on an incremental infusion of dextran 40.

RESULTS:

The majority of patients destined to embolise will do so within the first 2 postoperative hours. Dextran therapy was instituted in nine patients (5%) and rapidly controlled this phase of embolisation although the dose had to be increased in three (33%). No patient suffered a postoperative carotid thrombosis but one suffered a minor stroke on day 5 and was found to have profuse embolisation on TCD; high dose dextran therapy was again instituted, the embolus count rate fell rapidly and he made a good recovery thereafter. Overall, the death and disabling stroke rate was 1.2% and the death/any stroke rate was 2.4%.

CONCLUSION:

Three hours of postoperative TCD monitoring is as effective as 6 h in the prevention of postoperative carotid thrombosis.

• Authors: N Lennard, J L Smith, P Hayes, D H Evans, R J Abbott, N J London, P R Bell, A R Naylor
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 17 Issue 4 Pg. 301-5 (Apr 1999) ISSN: 1078-5884 [Print] England
• PMID: 10204051 (Publication Type: Journal Article)

Chemical References

• Dextrans

Topics

• Adult
• Aged
• Carotid Artery Thrombosis (diagnostic imaging, mortality, prevention & control)
• Carotid Artery, Internal (diagnostic imaging, surgery)
• Dextrans (administration & dosage)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Endarterectomy, Carotid
• Female
• Humans
• Infusions, Intravenous
• Intracranial Embolism and Thrombosis (diagnostic imaging, mortality, prevention & control)
• Male
• Middle Aged
• Monitoring, Physiologic
• Postoperative Complications (diagnostic imaging, mortality, prevention & control)
• Prospective Studies
• Risk Factors
• Survival Rate
• Ultrasonography, Doppler, Transcranial (drug effects)