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


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


METHODS
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%.


CONCLUSIONS
Three hours of postoperative TCD monitoring is as effective as 6 h in the prevention of postoperative carotid thrombosis.
Lennard
N
N
Department of Vascular Surgery, Leicester Royal Infirmary, U.K.
Smith
J L
JL
Hayes
P
P
Evans
D H
DH
Abbott
R J
RJ
London
N J
NJ
Bell
P R
PR
Naylor
A R
AR
D000328:Adult; D000368:Aged; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D003911:Dextrans / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017585:Ultrasonography, Doppler, Transcranial / Q000187:drug effects
D003911:Dextrans