Key result
Tirofiban therapy rapidly reduced the median rate of cerebral microemboli to 0 per hour in patients before and after carotid endarterectomy (P<0.001).
Why the study?
Does tirofiban reduce the rate of cerebral microemboli in patients with critical carotid stenosis before and after carotid endarterectomy?
Observational (n=33)
Does tirofiban reduce the rate of cerebral microemboli in patients with critical carotid stenosis before and after carotid endarterectomy?
p-value: p=<0.001
Tirofiban rapidly and effectively controls cerebral microemboli detected by transcranial Doppler ultrasonography in patients with critical carotid stenosis undergoing carotid endarterectomy.
Tirofiban may control microemboli around carotid endarterectomy; hypothesis-generating and requires randomized confirmation before practice change.
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.
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Dellen et al. (2008) conducted an observational in Transient ischaemic attacks or carotid endarterectomy with microembolic signals (n=33). Tirofiban vs. Baseline (pre-treatment) was evaluated on Rate of microemboli (p=<0.001). Tirofiban therapy rapidly reduced the median rate of cerebral microemboli to 0 per hour in patients before and after carotid endarterectomy (P<0.001).
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