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We agree with Filis et al1 that in total, further investigation of the incidence and management of perioperative myocardial infarction (MI) after carotid endarterectomy (CEA) or carotid artery stent (CAS) is needed. However, it is important to avoid conflation of asymptomatic perioperative MI with isolated perioperative cardiac marker elevation in this context. Although the former represents either type I or type II MI according to the third universal definition for MI,2 the latter may instead be a function of pre-existing disease processes such as chronic kidney disease or congestive heart failure. Such comorbidities are frequently present in patients who …

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Response to Letter Regarding Article, “Non-ST-Segment–Elevation Myocardial Infarction in Patients Undergoing Carotid Endarterectomy or Carotid Artery Stent Placement”