Unit:
Τομέας ΧειρουργικήςLibrary of the School of Health Sciences
Dissertation committee:
Ιωάννης Μπράμης, Κωνσταντίνος Φίλης, Φραγκίσκα Σιγάλα
Original Title:
Εκτίμηση της καρδιακής βλάβης μετά από καρωτιδική ενδαρτηρεκτομή ή ενδοαγγειακή καρωτιδική αγγειοπλαστική για συμπτωματική στένωση καρωτιδικού διχασμού
Summary:
Aim of the study: Carotid disease is a chronic disease of high incidence and
mortality. A great percentage of patients with carotid disease have coronary
disease as well. Two interventional methods are used today for therapy of
carotid disease, open carotid endarterectomy (CEA) and intravascular
angioplasty with stenting (CAS). Aim of our study is to evaluate the
perioperative cardiac damage of both methods and to compare the results between
different groups of cardiac risk.
Methods: 162 patients were scheduled for CEA and 18 patients for CAS. All
patients had coronary disease. The SAPPHIRE criteria for stratifying patients
considered for carotid endarterectomy in normal and high surgical risk groups,
were used prospectively. Patients were also classified preoperatively in groups
of perioperative cardiac risk, according (i) to the Vascular Study Group of New
England-Risk Cardiac Index (VSG-RCI), (ii) to the findings of stress
echocardiography with dobutamine and (iii) to the results of coronary
angiography, when indicated. All patients had preoperative full cardiologic
evaluation and cTn-I values, as well as on the 1st, 3rd and 7th day
postoperatively. Postoperative cTn-I values from 0.05 ng/ml to 0.5 ng/ml were
classified as myocardial ischemia and values over 0.5 ng/ml as myocardial
infarction.
Results: Mortality after CEA was 0.6%, stroke rate was null, cardiac damage
rate was 14% and symptomatic myocardial infarction rate was null. Mortality
after CAS was null, stroke rate was null and cardiac damage rate was null. All
patients with increased cTn-I were asymptomatic. In both series, all patients
raised their troponin values postoperatively regardless of cardiac damage.
Patients after CEA raised their troponin values more than patients after CAS
and showed more cardiac adverse events. There was no statistical difference of
the troponin values by patients after CEA, between groups of low and high
surgical risk. Patients of low and medium cardiac risk, according to VSG-RCI
and stress echocardiography, showed higher cTnI values after CEA and the most
adverse cardiac events, as well. There was no statistical difference in
troponin values between groups of same cardiac risk but different
classification method, in patients without perioperative cardiac damage.
Echogenic and Type IV carotid plaques were associated with high cardiac risk
according to the results of preoperative coronary angiography and with
perioperative cardiac damage.
Conclusions: Coronary patients, regardless of their cardiac risk, raise their
troponin and are in danger of perioperative cardiac damage, after both CEA and
CAS. Patients in high cardiac risk do not result in a higher risk for
perioperative cardiac damage. Echogenic and Type IV carotid plaques are
associated with the severity of coronary artery disease and with perioperative
cardiac damage. A protocol of standardized troponin measurement after CEA or
CAS is required to be established for the detection of silent cardiac damage,
especially for coronary patients. Larger studies are needed to verify our
results.
Keywords:
Carotid endarterectomy, Endovascular angioplasty, Cardiac damage, Myocardial ischemia, Risk stratification
Number of references:
238
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