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Perioperative Stroke Risk Model —One Size Fits All?
The article by Glance et al is an important and timely contribution to the field of perioperative medicine. While evidence-based consensus statements help guide clinicians to make the best decisions for patients, they are only as good as the data and populations on which they are based. In these cases, overestimation of risk of perioperative stroke might lead to unnecessary surgical delays, especially for semiurgent surgeries (ie, cancer), and unnecessary intraoperative neurological monitoring and may significantly impact patient care and health care system cost. Furthermore, while we now have a better understanding of the...
Source: JAMA Surgery - June 29, 2022 Category: Sports Medicine Source Type: research

Modern Treatment of Asymptomatic Carotid Stenosis —The Importance of Both Medical Therapy and Carotid Endarterectomy
Each year there are approximately 700  000 new ischemic strokes in the US, and 10% to 15% of them are caused by thromboembolism from a previously asymptomatic carotid stenosis (ACS). Three large randomized clinical trials, published in the 1990s and early 2000s, have demonstrated a significant benefit of carotid endarterectomy (CEA) i n preventing stroke in patients with severe ACS compared with medical therapy alone. They showed a 50% relative risk reduction in 5-year stroke rate and an approximately 1% per year absolute stroke risk reduction. Over the course of the past 2 decades, there has been significant improvement...
Source: JAMA Surgery - June 8, 2022 Category: Sports Medicine Source Type: research

Association between physical activity and sedentary behaviour on carotid atherosclerotic plaques: an epidemiological and histological study in 90 asymptomatic patients.
CONCLUSION: In this cross-sectional study of asymptomatic patients who underwent endarterectomy (i) higher reported PA, (ii) intensity of PA and (iii) lower reported SB were associated with lower prevalence of intraplaque haemorrhage. This could be a mechanism whereby PA protects against cerebrovascular disease (stroke) and death. PMID: 30842104 [PubMed - as supplied by publisher]
Source: British Journal of Sports Medicine - March 5, 2019 Category: Sports Medicine Authors: Mury P, Mura M, Della-Schiava N, Chanon S, Vieille-Marchiset A, Nicaise V, Chirico EN, Collet-Benzaquen D, Lermusiaux P, Connes P, Millon A, Pialoux V Tags: Br J Sports Med Source Type: research

Appropriateness of Carotid Endarterectomy in Asymptomatic Carotid Disease —Predicting 5-Year Survival
Guidelines from the Society for Vascular Surgery and the American Heart Association/American Stroke Asssociation recommend carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis if a patient ’s minimum life expectancy is 3 to 5 years. An estimated 20% of CEAs for asymptomatic carotid stenosis are performed in patients with life-limiting conditions. Given the rapidly aging surgical patient population in the United States, it is imperative that surgeons have the tools to adequately iden tify patients who will benefit from surgery.
Source: JAMA Surgery - January 9, 2019 Category: Sports Medicine Source Type: research

Optimal vs Feasible Volume Thresholds in Vascular Surgery
The volume-outcome relationship in vascular surgery has been an especially controversial topic recently, given the declining trainee exposure to complex open vascular cases, additional series reporting improved outcomes with higher volume, and medical organizations, such as Leapfrog, recommending volume thresholds for certain procedures. However, the definition of volume and the delineation of a specific threshold number of cases below which surgeons should not be credentialed remain unclear. In this issue ofJAMA Surgery, Mao et al took a unique approach to looking at outcomes among the very lowest-volume surgeons —those...
Source: JAMA Surgery - May 17, 2017 Category: Sports Medicine Source Type: research

Surgeon’s 30-Day Outcomes Supporting the Carotid Revascularization Endarterectomy versus Stenting Trial
Conclusions and RelevanceSimilar to CREST, the 30-day risk of composite major adverse events was equivalent for the 2 treatment modalities. We attribute our comparable incidence of perioperative stroke with CAS and CEA to improved patient selection. We excluded most patients older than 80 years and those with complex anatomy from consideration for CAS. Our results confirm those of CREST and demonstrate that both CEA and CAS can be performed safely by a vascular surgeon in properly selected patients.
Source: JAMA Surgery - November 12, 2014 Category: Sports Medicine Source Type: research