Stroke, Vol 18, 722-727, Copyright © 1987 by American Heart Association
JR Stratton, RE Zierler and A Kazmers
Following carotid endarterectomy, early postoperative thrombosis or late
restenosis occurs in up to 20% of vessels. Both complications may be
related to platelet mechanisms. To assess platelet deposition at
endarterectomy sites, we injected indium-111 labelled platelets in 24 men
less than 30 minutes after carotid endarterectomy, with subsequent imaging
24-96 hours later. To determine if deposition decreased over time, 12
patients had follow-up studies 0.5-24 months later. For comparison, 2
control groups were studied: 1) patients with noncarotid surgery (n = 6)
and 2) normal young subjects without endarterectomy and without evidence of
carotid disease (n = 12). Quantitative analysis was performed performed
using a deposition index that compared activity in operated with unoperated
sites in surgical patients or activity in the right with left carotid
arteries in normal subjects. Patients with recent endarterectomy had a mean
deposition index of 1.7 +/- 0.5 (range 1.2-3.5) compared with a similarly
determined ratio of 1.1 +/- 0.1 in normal subjects and 1.2 +/- 0.1 in the
surgical controls (both p less than or equal to 0.05 vs. acute
endarterectomy). At follow-up after endarterectomy, the mean deposition
index decreased to 1.0 +/- 0.1, documenting reduced platelet deposition
over time. We conclude that the arterial injury of carotid endarterectomy
results in early platelet deposition, which is no longer present in most
patients who are studied late. These findings suggest a reduction in
platelet thrombus formation with time and are compatible with
reendothelialization of the endarterectomized surface. This model may be
useful for the in vivo assessment of therapies designed to reduce platelet
accumulation following endothelial injury in humans.
ARTICLES
Platelet deposition at carotid endarterectomy sites in humans
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