Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease

Illuminati, Giulio; Schneider, Fabrice; Greco, Cesare; Madon, E; Schiariti, Michele; Tanzilli, Gaetano; Barillà, Francesco; Paravati, Vincenzo; Pizzardi, Giulia; Caliò, Francesco G.; Miraldi, Fabio; Macrina, Francesco; Totaro, Marco; Greco, Ernesto; Mazzesi, Giuseppe; Tritapepe, Luigi; Toscano, Michele; Vietri, F; Meyer, Nicolás; Ricco, Jean‐Baptiste

doi:10.1016/j.ejvs.2014.12.030

Cited by 78 publications

(37 citation statements)

References 40 publications

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“…Thus, myocardial revascularization may be recommended before elective noncardiac surgery in patients with evidence of extensive myocardial ischemia. 15 Cardiac troponin I, a component of the myocardial cell contractile apparatus, is the preferred biomarker for the diagnosis of myocardial infarction because it has high tissue specificity and clinical sensitivity. 24 Current evidence suggests that even a small increase in the blood level of cardiac troponin I in the perioperative period reflects clinically relevant myocardial injury with impaired cardiac prognosis.…”

Section: Discussionmentioning

confidence: 99%

Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomy

Kwon¹,

Moon

Han³

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Controversy persists regarding the optimal management of subclinical coronary artery disease (CAD) prior to carotid endarterectomy (CEA) and the impact of CAD on clinical outcomes after CEA. This study aimed to evaluate the short-term surgical risks and long-term outcomes of patients with subclinical CAD who underwent CEA. METHODS The authors performed a retrospective study of data from a prospective CEA registry. They analyzed a total of 702 cases involving patients without a history of CAD who received preoperative cardiac risk assessment by radionuclide myocardial perfusion imaging (MPI) and underwent CEA over a 10-year period. The management strategy (the necessity, sequence, and treatment modality of coronary revascularization and optimal perioperative medical treatment) was determined according to the presence, severity, and extent of CAD as determined by preoperative MPI and additional coronary computed tomography angiography and/or coronary angiography. Perioperative cardiac damage was defined on the basis of postoperative elevation of the blood level of cardiac troponin I (0.05-0.5 ng/ml) in the absence of myocardial ischemia. The primary endpoint was the composite of any stroke, myocardial infarction, or death during the perioperative period and all-cause mortality within 4 years of CEA. The associations between clinical outcomes after CEA and subclinical CAD were analyzed. RESULTS Concomitant subclinical CAD was observed in 81 patients (11.5%). These patients did have a higher incidence of perioperative cardiac damage (13.6% vs 0.5%, p < 0.01), but they had similar primary endpoint incidences during the perioperative period (2.5% vs.1.8%, p = 0.65) and similar estimated 4-year primary endpoint rates (13.6% vs 12.4%, p = 0.76) as the patients without subclinical CAD. Kaplan-Meier survival analysis showed that the 2 groups had similar rates of overall survival (p = 0.75). CONCLUSIONS Patients with subclinical CAD can undergo CEA with acceptable short- and long-term outcomes provided they receive selective coronary revascularization and optimal perioperative medical treatment.

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Section: Discussionmentioning

confidence: 99%

Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomy

Kwon¹,

Moon

Han³

et al. 2017

Journal of Neurosurgery

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“…This may be due to our policy of systematically performing preoperative coronary angiography in all patients who are candidates for carotid revascularization and of prophylactically treating significant coronary artery stenoses before carotid revascularization. 29,30 Following a recent percutaneous coronary intervention using drugeluting stents, we performed PCB under dual antiplatelet treatment in 28 patients (42%) without any cervical hematoma requiring surgical drainage.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery

Belmonte

Schneider

Pizzardi

et al. 2017

Journal of Vascular Surgery

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“…The latter difference in periprocedural MI between the two procedures may be attenuated by two recent randomised trials showing that systematic preoperative coronary angiography eventually followed by coronary stenting or coronary artery bypass grafting as clinically indicated in the preoperative workup of CEA significantly lowers myocardial ischaemic complications of CEA 55 56…”

Section: Carotid Stentingmentioning

confidence: 99%

Carotid artery stenting versus carotid endarterectomy

Nanna

Gomes

Njoh

et al. 2016

Postgraduate Medical Journal

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Stroke remains a significant contributor to morbidity and mortality in developed countries. Carotid artery stenosis is a major cause of stroke. Advances in medical therapy, surgical technique and endovascular maturation has resulted in options for the treatment of carotid stenosis. Here, we present a review of carotid artery stenting and carotid endarterectomy as it applies to trials comparing and contrasting the two treatment options. We also explore the intricacies surrounding reimbursement of these treatment strategies in the USA.

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Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease

Abstract: In asymptomatic coronary-artery patients, systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late MI and increases long-term survival. (ClinicalTrials.gov number, NCT02260453).

Cited by 78 publications

References 40 publications

Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomy

Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomy

Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery

Carotid artery stenting versus carotid endarterectomy

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