Dextran as an Adjunct in Carotid Endarterectomy: A Systematic Review and Meta Analysis

Abstract

ABSTRACT BACKGROUND Carotid endarterectomy (CEA) is a widely used surgical procedure to prevent stroke in patients with carotid artery stenosis. Dextran, an antithrombotic agent with antihemostatic properties, has been proposed as an adjunctive therapy to reduce thromboembolic complications during CEA. However, its effectiveness and safety remain controversial. This systematic review and meta-analysis aim to assess the incidence of thromboembolic and haemorrhagic complications in patients undergoing CEA with dextran administration. MATERIALS AND METHODS A systematic search was conducted in MEDLINE, Scopus, and Web of Science for studies evaluating the postoperative effects of dextran in CEA patients. Random-effects meta-analysis was performed to estimate the pooled incidence of adverse events, and heterogeneity was assessed through meta-regression analysis. The quality of the included studies was evaluated using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational studies and the Cochrane Risk of Bias 2 tool for randomized controlled trials (RCTs). RESULTS Ten studies, including a total of 149,540 patients, met the inclusion criteria. Of these, nine were observational cohort studies (six retrospective and three prospective), while one was an RCT. The meta-analytical incidence of stroke following CEA with dextran was 0.7% (95% CI: 0.3%-1.1%), with moderate heterogeneity (I² = 50.79%, p = 0.002). Meta-regression analysis indicated that geographic region significantly contributed to heterogeneity (p = 0.010), while other clinical covariates, such as diabetes, hypertension, and coronary artery disease, were not associated with significant variations in outcomes. Dextran was primarily administered selectively to high-risk patients, with variations in dosing protocols across studies. CONCLUSION The use of dextran in CEA was associated with a low incidence of thromboembolic events. However, some heterogeneity among studies highlights the need for further large-scale RCTs to clarify its efficacy and safety. Given the potential risks of dextran, including haemorrhage and renal complications, individualized patient selection and standardized administration protocols are recommended.