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Transcranial Doppler ultrasonography-directed intravenous glycoprotein IIb/IIIa receptor antagonist therapy to control transient cerebral microemboli before and after carotid endarterectomy
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van Dellen, D., Tiivas, C. A. S., Jarvi, K., Marshall, C., Higman, D. J. and Imray, C. (Chris) (2008) Transcranial Doppler ultrasonography-directed intravenous glycoprotein IIb/IIIa receptor antagonist therapy to control transient cerebral microemboli before and after carotid endarterectomy. British Journal of Surgery, Vol.95 (No.6). pp. 709-713. doi:10.1002/bjs.6204 ISSN 0007-1323.
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Official URL: http://dx.doi.org/10.1002/bjs.6204
Abstract
Background:
Patients with a transient focal neurological deficit, critical carotid stenosis and/or microemboli detected by transcranial Doppler ultrasonography (TCD) have a significant risk of stroke. The effect of tirofiban, a selective glycoprotein IIb/IIIa inhibitor, was assessed in patients with microembolic signals on TCD after transient ischaemic attacks or carotid endarterectomy (CEA).
Methods:
Thirty-three patients with microemboli on TCD (13 symptomatic preoperative, 19 postoperative, one both) were treated with tirofiban between 2002 and 2007. All patients had carotid stenosis greater than 70 per cent. TCD monitoring was used during and after tirofiban therapy.
Results:
The median (range) rate of microemboli decreased from 22 (4–260) per h before surgery and 81 (44–216) per h after surgery to 0 (0–9) per h in both groups (P < 0·001, Mann–Whitney U test). This occurred rapidly (preoperative median 30 min; postoperative median 45 min) and was well tolerated in all patients, with no serious adverse effects.
Conclusion:
Cerebral microemboli were controlled by tirofiban both before and after CEA. Further study is required to compare the relative efficacy of tirofiban and dextran. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | British Journal of Surgery | ||||
| Publisher: | John Wiley & Sons Ltd. | ||||
| ISSN: | 0007-1323 | ||||
| Official Date: | June 2008 | ||||
| Dates: |
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| Volume: | Vol.95 | ||||
| Number: | No.6 | ||||
| Page Range: | pp. 709-713 | ||||
| DOI: | 10.1002/bjs.6204 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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