A randomised, controlled trial of 10% dextran 40 in the prevention of stroke complicating carotid endarterectomy

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The operation to remove blockages in the carotid arteries (carotid endarterectomy) is of proven benefit in the prevention of stroke. The procedure itself, however, unfortunately carries approximately a 1 in 20 risk of immediate and early postoperative stroke. Most strokes are caused by blood clots forming at the operation site, breaking off and travelling to the brain (embolism). The up front operative risk is usually accepted by most patients in order to achieve the significantly greater long term benefits of future stroke risk reduction. This study is designed to test a medication (dextran) thought to possibly prevent stroke associated with the operation. Dextran acts in part, by preventing blood clots forming at the operation site . In a pilot study undertaken by the researchers, dextran significantly reduced the downstream shedding of small blood clots (microemboli) detected by monitoring brain arteries using specialised ultrasound techniques. It remains to be proven, however, whether this effect on microemboli actually translates into the prevention of stroke complicating surgery. The DICE (Dextran In Carotid Endarterectomy) Trial aims to assess whether dextran can reduce the risk of stroke associated with carotid surgery by 50% or more. It has important implications for the increasing numbers of Australians being offered this operation (5,000-6,000 each year). If the therapy is proven effective there will be the potential to prevent 350-450 strokes and stroke related deaths each year.