Browsing by Author "Jonsson, Magnus (25649493800)"

Objective: This study aimed to analyse the influence of different methods of monitoring cerebral perfusion (MCP) on stroke, death, and use of intraluminal shunt during carotid endarterectomy (CEA). Methods: A systematic review and network meta-analysis was conducted and registered in the PROSPERO registry (CRD42021246360). Medline, Embase, CENTRAL, and Web of Science were searched. Randomised controlled trials (RCTs) and cohort studies with > 50 participants that compared clinical outcomes for different MCP in patients undergoing CEA were included. Papers reporting one or a combination of two of the following MCPs were included in the analysis: awake testing (AT), near infrared spectroscopy (NIRS), electroencephalography (EEG), somatosensory evoked potential (SSEP), motor evoked potential (MEP), transcranial Doppler (TCD), and stump pressure (SP). A random effects network meta-analysis was performed using a binomial likelihood function with a specified logit link for peri-operative stroke or death and shunting as outcomes. Near infrared spectroscopy was excluded due to the lack of studies that could be used for statistical analysis. Results: Of 1 834 publications, 17 studies (15 cohort studies and two RCTs) including 21 538 participants were incorporated in the quantitative analysis. Electroencephalography was used in the largest number of participants (7 429 participants, six studies), while AT was used in the highest number of studies (10 studies). All monitoring modalities had worse outcomes with respect to stroke or death when compared with AT, with ORs ranging between 1.3 (95% credible interval [CrI] 0.2 – 10.9) for SSEP + MEP and 3.1 (CrI 0.3 – 35.0) for patients monitored with a combination of EEG and TCD. However, the wide CrI indicated that there is no statistically significant difference between the monitoring methods. Patients monitored with a combination of EEG and TCD had the lowest odds of being shunted, while SP had the highest odds of being shunted, also with no statistically significant difference. Conclusion: There is a lack of high quality data on this topic in the literature. The present study showed no significant difference between monitoring methods investigated in the network meta-analysis. © 2022 European Society for Vascular Surgery

Purpose: Patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) are at substantially increased risk of short-term and long-term cardiac complications. Still, the role of perioperative troponin in predicting cardiac events remains unclear. The objective was to systematically summarize the existing evidence on the topic and provide directions for further research. Materials and Methods: Studies that examined perioperative troponin values and its association with myocardial injury, and/or myocardial infarction (MI), and/or major adverse cardiac events (MACE) and postoperative mortality in exclusively CEA/CAS patients, published in English until March 15, 2022, were retrieved through a systematic search of MEDLINE and Web of Science. The study selection process was independently performed by 2 authors, while the third researcher resolved disagreements. Results: Four studies with 885 participants met the inclusion criteria. Age, chronic kidney disease, presentation of carotid disease, type of closure (primary closure/venous patch/Dacron/polytetrafluoroethylene patch), coronary artery disease, chronic heart failure, and the long-term use of calcium channel blockers represent risk factors for troponin elevation, which occurred in 11% to 15.3%. Myocardial infarction and MACE occurred in 23.5% to 40%, that is, 26.5% of patients with troponin elevation, respectively, during the first 30 postoperative days. Elevated postoperative troponin levels were significantly associated with adverse cardiac events during the long-term surveillance period. The rates of cardiac-related and all-cause mortality were higher in patients with postoperative troponin elevation. Conclusion: Troponin measurement could be helpful in the prediction of adverse cardiac events. The predictive role of preoperative troponin, the patient population in whom routine troponin sampling should be used, and a comparison of different treatment methods/anesthesia techniques in carotid patients should be further examined. Clinical Impact: The present scoping review critically appraises the extent and nature of the existing literature data on the predictive value of troponin on the occurrence of cardiac complications in patients undergoing CEA and CAS. In particular, it provides clinicians with essential insights by systematically summarizing the core evidence and identifying knowledge gaps that may direct future research. This, in turn, may significantly alter the current clinical practice and perhaps even reduce the incidence of cardiac complications in patients undergoing CEA/CAS. © The Author(s) 2023.

Objective: To assess the prevalence and risk factors for the development of myocardial injury (MIn) in patients undergoing carotid revascularisation and to assess whether elevated troponin levels can predict the occurrence of adverse cardiac events and short term death. Methods: This prospective, multicentre cohort study included 527 patients subjected to carotid revascularisation from June to October 2023. High sensitive cardiac troponin I and or T were assessed pre-operatively, and eight and 24 hours post-operatively. Myocardial injury was defined as at least one value of cardiac troponin above the 99th percentile upper reference limit. Results: Four hundred and forty patients (83.5%) underwent carotid endarterectomy and 87 (16.5%) carotid artery stenting (85 under local infiltrative and two under general anaesthesia). Of the 527 patients, 87 (16.5%) were operated under general, 355 (67.4%) under regional anaesthesia, and the remaining 85 (16.1%) received local anaesthetic infiltration. Pre-operatively, MIn was noted in 7% of patients, and the overall prevalence of post-operative MIn was 12.3%. Age ≥ 81 years, pre-operative haemoglobin 10 – 13.9 g/dL and glomerular filtration rate 15 – 30 mL/min/1.73 m2 were independent predictors of post-operative MIn (OR 2.84, 95% CI 1.17 – 6.91, p =.021; OR 1.95, 95% CI 1.01 – 3.76, p =.046; OR 11.46, 95% CI 2.37 – 55.33, p =.002, respectively). Myocardial infarction (MI) developed in seven patients (1.3%), more frequently in those who had MIn eight and 24 hours following surgery (71.4% vs. 10.4%, p =.001; 71.4% vs. 10.2%, p =.001, respectively). Conclusion: Myocardial injury is common in patients undergoing carotid revascularisation; to reduce the rate of MIn, special attention should be paid to those patients with risk factors identified in the present study. Long term (one and two year) follow up of the TROPICAR patients will provide additional insights into the association between peri-operative Min, MI, and death. © 2025 European Society for Vascular Surgery