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Percorrer por autor "Myrcha, Piotr"

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  • Dextran as an adjunct in carotid endarterectomy: a systematic review and meta-analysis
    Publication . Silva-Vieira,Duarte; Pereira-Neves, António; Nzwalo, Hipólito; Myrcha, Piotr; Neves, João Rocha
    Background: Carotid endarterectomy (CEA) is a widely used surgical procedure to prevent stroke in patients with carotid artery stenosis. Dextran, an antithrombotic agent with antihemostatic properties, has been proposed as an adjunctive therapy to reduce thromboembolic complications during CEA. However, its effectiveness and safety remain controversial. This systematic review and meta-analysis aim to assess the incidence of thromboembolic and hemorrhagic complications in patients undergoing CEA with dextran administration. Methods: A systematic search was conducted in MEDLINE, Scopus, and Web of Science for studies evaluating the postoperative effects of dextran in CEA patients. Random-effects metaanalysis was performed to estimate the pooled incidence of adverse events, and heterogeneity was assessed through meta-regression analysis. The quality of the included studies was evaluated using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool for observational studies and the Cochrane Risk-of-Bias 2 tool for randomized controlled trials (RCTs). Results: Ten studies, including a total of 149,540 patients, met the inclusion criteria. Of these, 9 were observational cohort studies (6 retrospective and 3 prospective), while one was an RCT. The meta-analytical incidence of stroke following CEA with dextran was 0.7% at 30 days post operatively (95% confidence interval, 0.3e1.1%), with moderate heterogeneity (I2 ¼ 50.79%, P ¼ 0.002). Meta-regression analysis indicated that geographic region significantly contributed to heterogeneity (P ¼ 0.010), while other clinical covariates, such as diabetes, hypertension, and coronary artery disease, were not associated with significant variations in outcomes. Dextran was primarily administered selectively to high-risk patients, with variations in dosing protocols across studies. Conclusion: The use of dextran in CEA was associated with a low incidence of thromboembolic events. However, some heterogeneity among studies highlights the need for further large-scale RCTs to clarify its efficacy and safety. Given the potential risks of dextran, including hemorrhage and renal complications, individualized patient selection and standardized administration protocols are recommended.
    2025-11Artigo científico Acesso aberto Ver mais
  • Predictive factors driving positive awake test in carotid endarterectomy using machine learning
    Publication . Pereira-Macedo, Juliana; Duarte-Gamas, Luís; Pereira Pias, Ana Daniela; Myrcha, Piotr; Andrade, José P.; António, Nuno; Marreiros, Ana; Rocha-Neves, João
    Background: Positive neurologic awake testing during the carotid cross-clamping may be present in around 8% of patients undergoing carotid endarterectomy (CEA). The present work aimed to assess the accuracy of an artificial intelligence (AI)-powered risk calculator in predicting intraoperative neurologic deficits (INDs). Methods: Data was collected from carotid interventions performed between January 2012 and January 2023 under regional anesthesia. Patients with IND were selected along with consecutive controls without IND in a case-control study design. A predictive model for IND was developed using machine learning, specifically Extreme Gradient Boosting (XGBoost) model, and its performance was assessed and compared to an existing predictive model. Shapley Additive exPlanations (SHAP) analysis was employed for the model interpretation. Results: Among 216 patients, 108 experienced IND during CEA. The AI-based predictive model achieved a robust area under the curve of 0.82, with an accuracy of 0.75, precision of 0.88, sensitivity of 0.59, and F1Score of 0.71. High body mass index (BMI) increased contralateral carotid stenosis, and a history of limb paresis or plegia were significant IND risk factors. Elevated preoperative platelet and hemoglobin levels were associated with reduced IND risk. Conclusions: This AI model provides precise IND prediction in CEA, enabling tailored interventions for high-risk patients and ultimately improving surgical outcomes. BMI, contralateral stenosis, and selected blood parameters emerged as pivotal predictors, bringing significant advancements to decision-making in CEA procedures. Further validation in larger cohorts is essential for broader clinical implementation.
    2025-02Artigo científico Acesso restrito Ver mais