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

清除颈动脉阻塞的手术（颈动脉内膜切除术）已被证明对预防中风有益。然而，不幸的是，手术本身具有约1/20的术后即刻和早期卒中风险。大多数中风是由手术部位形成的血凝块引起的，血凝块破裂并进入大脑（栓塞）。大多数患者通常接受预先手术风险，以实现未来卒中风险降低的显著更大长期获益。这项研究的目的是测试一种药物（右旋糖酐），被认为可能预防与手术相关的中风。右旋糖酐的作用部分在于防止手术部位形成血凝块。在研究人员进行的一项试点研究中，右旋糖酐显着减少了通过使用专门的超声技术监测脑动脉检测到的小血凝块（微栓子）的下游脱落。然而，这种对微栓子的影响是否真的能预防手术并发中风还有待证实。DICE（Dextran in Carotid Endarterectomy）试验旨在评估右旋糖酐是否可以将与颈动脉手术相关的中风风险降低50%或更多。这对越来越多的澳大利亚人接受这种手术（每年5 000至6 000人）具有重要意义。如果该疗法被证明有效，每年将有可能预防350 - 450例中风和中风相关死亡。

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.