The value of troponin measurement in carotid revascularization: are we making the most of it?

Patients undergoing carotid endarterectomy and carotid artery stenting are susceptible to the development of adverse cardiac events. Perioperative myocardial injury - an entity characterized by increased values of cardiac troponins - is strongly associated with the occurrence of both short- and long-term cardiac adverse events, non-cardiac complications, poor treatment outcomes, and increased mortality. The silent nature of this condition, in most cases, emphasizes the significance of perioperative troponin measurement, which is reflected in its diagnostic, prognostic, and risk stratification value. Thus, the possible benefits of troponin screening represent the main aim of numerous studies in non-cardiac surgery patients. Still, this issue has not been sufficiently explored in patients undergoing carotid revascularization. Questions regarding the superiority of routine/selective screening, one troponin essay over the other, preoperative/postoperative/perioperative evaluation, the appropriate timing and duration of troponin measurement, the predictors of its elevation and patient-specific risk factors, the impact of different anesthesia techniques and methods of carotid revascularization, the predictive role of perioperatively elevated troponin, secondary preventive strategies, therapeutic measures, and its cost-effectiveness mostly remain unanswered. The present review provides a comprehensive overview of the current knowledge regarding the value of troponin measurement in patients undergoing carotid revascularization, critically appraises the up-to-date literature, and marks directions for future research in this area.