Transcranial Doppler ultrasonography-directed intravenous glycoprotein IIb/IIIa receptor antagonist therapy to control transient cerebral microemboli before and after carotid endarterectomy

The British Journal of Surgery
D van DellenC H E Imray

Abstract

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). 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. 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. Cerebral microemboli were controlled by tirofiban both before and after CEA. Further study is required to compare the relative efficacy of tirofiban and dextran.

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Citations

Dec 24, 2011·Stroke Research and Treatment·Vlasta Vuković-Cvetković
May 27, 2014·Surgery·Oliver T R Toovey, Gregory J E Dickens
Jun 19, 2013·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·A R NaylorP R F Bell
Nov 15, 2008·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·R Y SharpeA R Naylor
May 11, 2010·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·R Y SharpeA R Naylor
Aug 20, 2011·Stroke; a Journal of Cerebral Circulation·Mario SieblerJochen B Fiebach
Oct 23, 2012·Stroke; a Journal of Cerebral Circulation·Mahmud SaedonChristopher H E Imray
Apr 7, 2015·Journal of Athletic Training·Jay L AlbertsAnil K Thota
Jan 16, 2018·Journal of Athletic Training·Julianne D SchmidtL Stephen Miller

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