The 5-item Modified Frailty Index Does Not Predict Postoperative Myocardial Infarction or Mortality Following Carotid Endarterectomy

Frailty has previously been shown to predict adverse outcomes in patients undergoing carotid endarterectomy (CEA) including higher rates of myocardial infarction (MI), stroke, and mortality. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) has moved to supporting the 5-item modified frailty index (mFI-5). We aimed to determine if using this index would demonstrate a similar outcome profile in frail patients undergoing CEA.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Vascular Surgery Source Type: research

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A 2019 systematic review identified seven randomised controlled trials (RCTs)1 –7 comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS) in 3 467 patients with asymptomatic carotid stenoses.8 When CAS was compared with CEA, meta-analysis revealed no significant differences in 30 day death, disabling stroke, myocardial infarction (MI), and death/any stroke/ MI.8 There were insufficient data to meta-analyse 30 day rates of death/disabling stroke. CAS was, however, associated with significantly higher rates of 30 day “any” stroke and 30 day death/any stroke.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Tags: Research Letter Source Type: research
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are accepted revascularization modalities to treat carotid artery disease. Higher incidences of perioperative adverse neurological events and death have been reported in transfemoral CAS patients. Transcarotid artery revascularization (TCAR) is a newer operative technique that involves direct transcervical carotid access, minimizing the risk of embolic stroke via cerebral blood flow reversal. Perioperative stroke, myocardial infarction (MI), and death rates have been shown to be similar between TCAR and CEA, with TCAR having less complications.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Vascular Surgery Source Type: research
CONCLUSIONS: The incidence of stroke and death were not convincingly different between local and general anaesthesia for people undergoing carotid endarterectomy. The current evidence supports the choice of either approach. Further high-quality studies are still needed as the evidence is of limited reliability.PMID:34642940 | DOI:10.1002/14651858.CD000126.pub5
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Source Type: research
We would like to thank Lazarides et  al in their letter to the editor regarding our report “Literature Review of Primary versus Patching versus Eversion as Carotid Endarterectomy Closure.”1 We agree with most of their comments. However, we did include a meta-analysis by Texakalidis et al.2 They had performed a meta-analysis of r andomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy (CEA), which showed that the incidence of 30-day stroke, myocardial infarction, wound infection, death, cranial nerve injury, carotid artery thrombosis, and death were comparable.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Letter to the Editor Source Type: research
Transcarotid arterial revascularization (TCAR) has been associated with a lower risk of stroke or death compared with transfemoral carotid artery stenting (TFAS) and a lower risk of cranial nerve injury and myocardial infarction than carotid endarterectomy (CEA). To the best of our knowledge, no comparative studies have been performed of the costs between TCAR, CEA, and TFAS, which could have important implications on institutional support for the new modality to address carotid artery stenosis.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
CONCLUSION: EV derived pre-operative plasma levels of cystatin C, serpin C1, CD14, and serpin F2 were independently associated with an increased long term risk of MACE after CEA and are thus markers for residual cardiovascular risk. EV derived CD14 levels could improve the identification of high risk patients who may benefit from secondary preventive add on therapy in order to reduce future risk of MACE.PMID:34511318 | DOI:10.1016/j.ejvs.2021.06.039
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Source Type: research
CONCLUSIONS: CAS and CEA appear to have a similar safety and efficacy profile in patients with radiation-induced carotid artery stenosis. Patients treated with CEA have a higher risk for periprocedural CN injuries. Future prospective studies are warranted to validate these results.PMID:33885270 | DOI:10.33963/KP.15956
Source: Kardiologia Polska - Category: Cardiology Authors: Source Type: research
We read with great interest the recent article by Lumas and colleagues, entitled “Regional Anesthesia is Underutilized for Carotid Endarterectomy Despite Improved Perioperative Outcomes Compared with General Anesthesia.”1 This retrospective study of 26,206 carotid endarterectomy (CEA) patients demonstrated a small but statistically significant decrease in composite rates of 30-day mortality, myocardial infarction (MI), and stroke among patients who received regional, as opposed to general, anesthesia.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Source Type: research
We read with great interest the recent article by Lumas and colleagues, entitled “Regional Anesthesia is Underutilized for Carotid Endarterectomy Despite Improved Perioperative Outcomes Compared with General Anesthesia.”1 This retrospective study of 26,206 carotid endarterectomy (CEA) patients demonstrated a small but statistically significant decrease in composite rates of 30-day mortality, myocardial infarction (MI), and stroke among patients who received regional, as opposed to general, anesthesia.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Source Type: research
CONCLUSIONS: For patients requiring CEA and CABG, performing both operations under general anaesthesia in the same session was safer than initially performing CEA under cervical block anaesthesia followed by CABG under general anaesthesia.PMID:33729273 | DOI:10.5830/CVJA-2020-042
Source: Cardiovascular Journal of Africa - Category: Cardiology Authors: Source Type: research
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