Cardiac damage after carotid intervention: a meta-analysis after a decade of randomized trials

Galyfos, George; Sigala, Fragiska; Karanikola, Evridiki; Loizou, Chrisoula; Toutouzas, Konstantinos; Filis, Konstantinos

doi:10.1007/s00540-014-1843-5

Cited by 17 publications

(11 citation statements)

References 37 publications

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“…A meta-analysis of seven observational studies and two RCTs (5959 patients) observed that CAS was associated with a significant reduction in ECG diagnosed MI or non-ST elevation MI (NSTEMI) with troponin elevation (OR 0.37, 95% CI 0.22e0.61, p ¼ .0001). 201 The significance of perioperative MI (especially NSTEMI with biomarker elevation) has been a source of controversy since its inclusion within the primary endpoint in SAPPHIRE and CREST. 104,189 The rationale for including perioperative MI was because historical studies had suggested that it was associated with poorer long-term survival.…”

Section: Survival Following Perioperative Stroke or Myocardial Infarcmentioning

confidence: 99%

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Naylor¹,

Ricco²,

Borst³

et al. 2018

European Journal of Vascular and Endovascular Surgery

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965

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Section: Survival Following Perioperative Stroke or Myocardial Infarcmentioning

confidence: 99%

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Naylor¹,

Ricco²,

Borst³

et al. 2018

European Journal of Vascular and Endovascular Surgery

1,005

965

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“…This difference between symptomatic and asymptomatic patients is also observed among patients undergoing CEA or tfCAS. 5 However, no difference was found when the study with the largest size effect on the analysis was left out. Hence, this study by Schermerhorn et al evaluated patients from the VQI registry and was not a prospectively designed study.…”

Section: Discussionmentioning

confidence: 99%

“…Open surgery is associated with higher surgical stress, and this could be the cause of the higher cardiac risk compared with stenting. 5 Moreover, carotid bifurcation and plaque manipulation during CEA increase the risk of thromboembolic events 6 as well as the risk of cranial nerve injuries. 7 On the other hand, manipulations with wires and endovascular devices during tfCAS could dislodge debris from a calcified aortic arch or cause dissections, leading to cerebrovascular events.…”

Section: Introductionmentioning

confidence: 99%

Editor's Choice – Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

Galyfos

Tsoutsas

Konstantopoulos

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis systematic review summarises the evidence for transcarotid revascularisation (TCAR) in patients with internal carotid artery stenosis. This technique offers an alternative strategy in patients where carotid endarterectomy (CEA) or transfemoral stenting face difficulties. This review evaluates early and late outcomes of the method in contrast to other similar reviews. Data indicate that TCAR is safe and efficient although symptomatic patients still carry a higher risk of early cerebrovascular complications. Prospectively designed studies comparing outcomes between TCAR and CEA in symptomatic patients are needed to further evaluate the benefit of this technique.Objective: Transcarotid/transcervical revascularisation (TCAR) is an alternative to carotid endarterectomy (CEA) and transfemoral carotid stenting (tfCAS). This review aimed to evaluate pooled data on patients undergoing TCAR. Data sources: Medline, Embase, Scopus, and Cochrane Library databases were used. Review methods: This systematic review was conducted under Systematic Reviews and Meta-Analysis guidelines. Eligible studies (published online up to September 2020) reported 30 day mortality and stroke/transient ischaemic attack (TIA) rates in patients undergoing TCAR. Data were pooled in a random effects model and weight of effect for each study was also reported. Quality of studies was evaluated according to Newcastle e Ottawa scale. Results: Eighteen studies (three low, seven medium, and eight high quality) included 4 852 patients (4 867 TCAR procedures). The pooled 30 day mortality rate was 0.7% (n ¼ 32) (95% confidence interval [CI] 0.5 e 1.0), 30 day stroke rate 1.4% (n ¼ 62) (95% CI 1.0 e 1.7), and 30 day stroke/TIA rate 2.0% (n ¼ 92) (95% CI 1.4 e 2.7). Pooled technical success was 97.6% (95% CI 95.9 e 98.8). The cranial nerve injury rate was 1.2% (95% CI 0.7 e 1.9) (n ¼ 14; data from 10 studies) while the early myocardial infarction (MI) rate was 0.4% (95% CI 0.2 e 0.6) (n ¼ 16; data from 17 studies). The haematoma/bleeding rate was 3.4% (95% CI 1.7 e 5.8) (n ¼ 135; data from 10 studies), with one third of these cases needing drainage or intervention. Within a follow up of 3 e 40 months the restenosis rate was 4% (95% CI 0.1 e 13.1) (data from nine studies; n ¼ 64/530 patients) and death/stroke rate 4.5% (95% CI 1.8 e 8.4) (data from five studies; n ¼ 184/3 742 patients). Symptomatic patients had a higher risk of early stroke/TIA than asymptomatic patients (2.5% vs. 1.2%; odds ratio 1.99; 95% CI 1.01 e 3.92); p ¼ .046; data from eight studies). Conclusion: TCAR is associated with promising early and late outcomes, with symptomatic patients having a higher risk of early cerebrovascular events. More prospective comparative studies are needed in order to verify TCAR as an established alternative treatment technique.

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“…within 30 days of surgery) in the study population was 3.6% (Table 3), which is considerably higher than the pooled incidence of 2.3% that was reported in a recent meta-analysis. 12 This difference can be explained by heterogeneity regarding study populations, MI definitions, and incorporation of routine post-operative biomarker assessment. For instance, the CREST trial which reported a MI incidence of 2.3% assessed cardiac biomarkers 6e8 hours after surgery and used a definition of post-operative MI that allowed for use of creatinine kinase MB fraction (CK-MB).…”

Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Cardiac Troponin Assessment in Patients Undergoing Carotid Endarterectomy

Grobben

Vrijenhoek

Nathoe

et al. 2016

European Journal of Vascular and Endovascular Surgery

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Cardiac damage after carotid intervention: a meta-analysis after a decade of randomized trials

Abstract: Compared to open surgery, CAS is associated with significantly decreased risk for symptomatic and asymptomatic cardiac damage postoperatively. Therefore, a standardized troponin measurement after CEA should be further evaluated in future studies.

Cited by 17 publications

References 37 publications

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Editor's Choice – Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

Clinical Relevance of Cardiac Troponin Assessment in Patients Undergoing Carotid Endarterectomy

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