title: Clopidogrel load for emboli reduction in patients with symptomatic carotid stenosis undergoing urgent carotid endarterectomy.
abstract: OBJECTIVE
  Microembolic signals (MES) on transcranial Doppler are an independent risk factor for recurrent stroke in patients with extracranial symptomatic/asymptomatic carotid artery stenosis (CARAS). Clopidogrel load (300 mg) combined with dual antiplatelet therapy has been shown to reduce MES in patients with symptomatic CARAS. We sought to determine feasibility of clopidogrel load in decreasing asymptomatic embolization in patients with symptomatic CARAS undergoing urgent carotid endarterectomy within the first 2 weeks from the index event.  Subjects and
  
  
  METHODS
  Consecutive patients with symptomatic CARAS (70%-99%) and presence of MES on 1-hour baseline (<24 hours from the index event) transcranial Doppler monitoring of ipsilateral middle cerebral artery were treated with clopidogrel load followed by clopidogrel (75 mg)±aspirin (100 mg) during the elapsed time period between hospital admission and urgent carotid endarterectomy at 3 tertiary-care stroke centers. Repeat 1-hour transcranial Doppler monitoring was performed the day before surgery. Bleeding complications during surgery and recurrent strokes or transient ischemic attacks during the first month of ictus were prospectively recorded.
  
  
  RESULTS
  A total of 11 symptomatic CARAS patients (mean age, 66±7 years; 73% men; 64% acute ischemic strokes) were treated with clopidogrel load followed by dual (67%) or single (33%) antiplatelet therapy. MES count was significantly reduced between baseline (median count, 8 MES/h; interquartile range, 6-19) and repeat transcranial Doppler monitoring (0 MES/h; interquartile range, 0-3; P=0.003). No bleeding complications, recurrent strokes, or transient ischemic attacks were documented.
  
  
  CONCLUSIONS
  Our pilot observational study provides preliminary nonrandomized data regarding the potential efficacy of clopidogrel load to reduce asymptomatic embolization in patients with symptomatic CARAS before urgent carotid endarterectomy.
authors.affiliation: Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece, Kapodistriou 3, Nea Xili, Alexandroupolis, Greece, 68100. tsivgoulisgiorg@yahoo.gr
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Antonios
authors.initials: A
authors.lastname: Kerasnoudis
authors.forename: Christos
authors.initials: C
authors.lastname: Krogias
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vadikolias
authors.forename: Saskia H
authors.initials: SH
authors.lastname: Meves
authors.forename: Ioannis
authors.initials: I
authors.lastname: Heliopoulos
authors.forename: Efstratios
authors.initials: E
authors.lastname: Georgakarakos
authors.forename: Charitomeni
authors.initials: C
authors.lastname: Piperidou
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D000077144:Clopidogrel; D004638:Emergency Treatment / Q000009:adverse effects; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011446:Prospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014463:Ultrasonography
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine