Transcranial Doppler-directed Dextran-40 therapy is a cost-effective method of preventing carotid thrombosis after carotid endarterectomy

Objectives: perioperative stroke reduces the clinical effectiveness of caro tid endarterectomy (CEA). Postoperative thrombotic stroke may be reduced in incidence by the use of transcranial Doppler-directed Dextran-40 therapy. This programme requires the purchase of additional equipment and employment of more staff. This study examined whether this additional financial outla y was cost-effective in terms of saving expenditure by preventing postopera tive thrombotic stroke. Materials and methods: data was collected prospectively on a series of 600 consecutive CEAs. The costs of the monitoring programme were analysed over 1- and 5-year periods. Formulae were derived allowing other units to calcul ate whether this technique will be cost-effective for them. Results: after the introduction of TCD monitoring the postoperative thrombo tic stroke rate from 2.7% to 0% (8 strokes prevented). Our local unit cost for the treatment of stroke was pound 25 702. After allowing for the additi onal costs of the monitoring programme, we calculate that postoperative TCD has saved pound 171 393. Conclusions: postoperative TCD monitoring is a clinically effective and als o cost-effective method of reducing the stroke rate associated with CEA. Fo r units performing more than 50 CEAs per year who experience occasional pos toperative carotid thrombosis, its introduction should be considered.