Carotid artery stenting versus endarterectomy in relation to perioperative myocardial ischemia, troponin T release and major cardiac events.
BACKGROUND
Carotid artery stenting (CAS) is less invasive than endarterectomy. This study examined differences in perioperative myocardial ischemia, troponin T release and clinical cardiac events in patients undergoing CAS compared with endarterectomy.


METHODS
In an observational study, CAS was performed in 24 and carotid endarterectomy in 44 patients. Before surgery, clinical risk factors were noted and dobutamine stress echocardiography was performed for cardiac risk assessment. Perioperative continuous 72-h 12-lead electrocardiographic monitoring was used for myocardial ischemia detection. Troponin T (>0.03 ng/ml) was measured on postoperative days 1, 3, 7 or before discharge. Cardiac events (cardiac death or Q-wave myocardial infarction) were noted during hospital stay and during follow-up (mean: 1.2 years).


RESULTS
No significant differences were observed between patients with CAS and endarterectomy in terms of baseline clinical characteristics, dobutamine stress echocardiography results and cardiovascular medication. Perioperative myocardial ischemia was detected in nine patients (13%), perioperative troponin T release in seven patients (10%), early cardiac events in one patient (1%) and late cardiac events in three patients (4%). Significantly less perioperative myocardial ischemia was observed in patients with CAS compared with endarterectomy (0 versus 21%, P=0.02). Troponin T release was also significantly lower in CAS, compared with endarterectomy (0 versus 16%, P=0.04). Early (0 versus 2%, P=0.5) and late (0 versus 7%, P=0.2) cardiac events were lower after CAS, compared with endarterectomy, although these differences were not significant.


CONCLUSIONS
CAS is associated with a lower incidence of perioperative myocardial ischemia and troponin T release, compared with endarterectomy.
Feringa
Harm H H
HH
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Hendriks
Johanna M
JM
Karagiannis
Stefanos
S
Schouten
Olaf
O
Vidakovic
Radosav
R
van Sambeek
Marc R H M
MR
Klein
Jan
J
Noordzij
Peter
P
Bax
Jeroen J
JJ
Poldermans
Don
D
D000368:Aged; D003324:Coronary Artery Disease / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D025401:Echocardiography, Stress; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D020107:Troponin T / Q000378:metabolism*
D020107:Troponin T