1
|
Sultan S, Acharya Y, Dulai M, Tawfick W, Hynes N, Wijns W, Soliman O. Redefining postoperative hypertension management in carotid surgery: a comprehensive analysis of blood pressure homeostasis and hyperperfusion syndrome in unilateral vs. bilateral carotid surgeries and implications for clinical practice. Front Surg 2024; 11:1361963. [PMID: 38638141 PMCID: PMC11025470 DOI: 10.3389/fsurg.2024.1361963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Background This study evaluates the implications of blood pressure homeostasis in bilateral vs. unilateral carotid surgeries, focusing on the incidence of postoperative hypertension, hyperperfusion syndrome, and stroke as primary outcomes. It further delves into the secondary outcomes encompassing major adverse cardiovascular events and all-cause mortality. Methods Spanning two decades (2002-2023), this comprehensive retrospective research encompasses 15,369 carotid referrals, out of which 1,230 underwent carotid interventions. A subset of 690 patients received open carotid procedures, with a 10-year follow-up, comprising 599 unilateral and 91 bilateral surgeries. The Society for Vascular Surgery Carotid Reporting Standards underpin our methodological approach for data collection. Both univariate and multivariate analyses were utilized to identify factors associated with postoperative hypertension using the Statistical Package for the Social Sciences (SPSS) Version 22 (SPSS®, IBM® Corp., Armonk, N.Y., USA). Results A marked acute elevation in blood pressure was observed in patients undergoing both unilateral and bilateral carotid surgeries (p < 0.001). Smoking (OR: 1.183, p = 0.007), hyperfibrinogenemia (OR: 0.834, p = 0.004), emergency admission (OR: 1.192, p = 0.005), severe ipsilateral carotid stenosis (OR: 1.501, p = 0.022), and prior ipsilateral interventions (OR: 1.722, p = 0.003) emerged as significant factors that correlates with postoperative hypertension in unilateral surgeries. Conversely, in bilateral procedures, gender, emergency admissions (p = 0.012), and plaque morphology (p = 0.035) significantly influenced postoperative hypertension. Notably, 2.2% of bilateral surgery patients developed hyperperfusion syndrome, culminating in hemorrhagic stroke within 30 days. Intriguingly, postoperative stage II hypertension was identified as an independent predictor of neurological deficits post-secondary procedure in bilateral CEA cases (p = 0.004), attributable to hyperperfusion syndrome. However, it did not independently predict myocardial infarction or mortality outcomes. The overall 30-day stroke rate stood at 0.90%. Lowest incidence of post operative hypertension or any complications were observed in eversion carotid endartrertomy. Conclusion The study identifies postoperative hypertension as a crucial independent predictor of perioperative stroke following bilateral carotid surgery. Moreover, the study elucidates the significant impact of bilateral CEA on the development of post-operative hyperperfusion syndrome or stroke, as compared to unilateral CEA. Currently almost 90% of our carotid practice is eversion carotid endartrerectomy.
Collapse
Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, University of Galway, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
- The Euro Heart Foundation, Amsterdam, Netherlands
| | - Yogesh Acharya
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, University of Galway, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland
| | - Makinder Dulai
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, University of Galway, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, University of Galway, Galway, Ireland
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
| | - William Wijns
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
- The Euro Heart Foundation, Amsterdam, Netherlands
| | - Osama Soliman
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
- The Euro Heart Foundation, Amsterdam, Netherlands
| |
Collapse
|
2
|
Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A, Kakkos SK, Markus HS, McCabe DJH, Sillesen H, van den Berg JC, Vega de Ceniga M, Venermo MA, Vermassen FEG, Esvs Guidelines Committee, Antoniou GA, Bastos Goncalves F, Bjorck M, Chakfe N, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kolh P, Koncar IB, Lindholt JS, Mees BME, Resch TA, Trimarchi S, Tulamo R, Twine CP, Wanhainen A, Document Reviewers, Bellmunt-Montoya S, Bulbulia R, Darling RC, Eckstein HH, Giannoukas A, Koelemay MJW, Lindström D, Schermerhorn M, Stone DH. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg 2023; 65:7-111. [PMID: 35598721 DOI: 10.1016/j.ejvs.2022.04.011] [Citation(s) in RCA: 166] [Impact Index Per Article: 166.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 01/17/2023]
|
3
|
GERMANOVA O, GALATI G, VACHEV A, GERMANOV A, BIONDI-ZOCCAI G. Carotid endarterectomy: the optimal surgical technique from the point of view of cardiologist. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
4
|
Reslan OM, McPhee JT, Brener BJ, Row HT, Eberhardt RT, Raffetto JD. Peri-Procedural Management of Hemodynamic Instability in Patients Undergoing Carotid Revascularization. Ann Vasc Surg 2022; 85:406-417. [PMID: 35395375 DOI: 10.1016/j.avsg.2022.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
Acute perioperative changes in arterial pressure occur frequently, particularly in patients with cardiovascular disease or those receiving vasoactive medications, or in relation to certain cardiovascular surgical procedures. Hemodynamic Instability (HI) are common in patients undergoing carotid revascularization because of unique patho-physiological and surgical factors. The operation, by necessity, disrupts the afferent pathway of the baroreflex, which can lead to postendarterectomy HI. Poor arterial pressure control is associated with increased morbidity and mortality after carotid revascularization, but good control of arterial pressure is often difficult to achieve in practice. The incidence, implications, and etiology of HI associated with carotid surgery are reviewed, and some recommendations made for its management. Close monitoring and titration of therapy are probably the most important considerations rather than specific choice of agents.
Collapse
Affiliation(s)
- Ossama M Reslan
- VA Fargo HCS, Fargo ND, Division of Vascular Surgery, Department of Surgery; University of North Dakota School of Medicine & Health Sciences, Department of Surgery.
| | - James T McPhee
- VA Boston HCS, West Roxbury MA, Division of Vascular Surgery, Department of Surgery; Boston University School of Medicine, Boston Medical Center
| | - Bruce J Brener
- Newark Beth Israel Medical Center, Division of Vascular Surgery, Department of Surgery
| | - Hunter T Row
- University of North Dakota School of Medicine & Health Sciences, Department of Surgery
| | - Robert T Eberhardt
- Boston University School of Medicine, Boston Medical Center; Division of Cardiovascular Medicine, Department of Medicine
| | - Joseph D Raffetto
- VA Boston HCS, West Roxbury MA, Division of Vascular Surgery, Department of Surgery; Harvard Medical School, Brigham and Women's Hospital
| |
Collapse
|
5
|
Djedovic M, Hadzimehmedagic A, Rustempasic N, Granov N, Haxhibeqiri-Karabdic I. The Impact of Unilateral and Bilateral Eversion Carotid Endarterectomy on Postoperative Hemodynamic Parameters. Med Arch 2021; 75:194-198. [PMID: 34483449 PMCID: PMC8385746 DOI: 10.5455/medarh.2021.75.194-198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
Background: Carotid endarterectomy (CEA) is an effective and safe treatment of stenosed carotid arteries, and is a preventive operation with well-defined indications. It is associated with a loss of the baroreceptor reflex and postoperatively increased hemodynamic parameters. Objective: The aim of the study was to confirm the sensitivity of baroreceptors and the impact on arterial pressure and heart rate in unilateral and bilateral eversion carotid endarterectomies. Methods: A retrospective study was conducted with 30 patients treated with E-CEA in local anesthesia at the Clinic for cardiovascular surgery from December 2019 to May 2021, due to stenosis of the carotid arteries. Patients were divided into two groups: 15 patients in group A (patients with unilateral E-CEA; 15 patients in group B: patients with bilateral E-CEA). Results: Out of the total of 30 patients included in the research, 15 patients in groups A and B respectively, there were no statistically significant differences in regards to gender (p= 0,245) and preoperative risk factors: smoking (p=0,449); hypertension (p=0,388); diabetes (p= 0,714); hyperlipidemia (p=0.388), coronary disease (p=0.461) and symptomatic stenosis of the carotid arteries (p=0.449). Noted were the statistically significant differences in values of systolic and diastolic pressure on the 3rd postoperative days in patients with bilateral E-CEA (p=0,001; p=0,001), a statistically significant difference in the heart rate was not found in the analyzed groups in the postoperative period (p=0,225; p=0,994). Conclusion: This study identified statistically significant differences in values of systolic and diastolic pressure in the early postoperative period. In his period, early detection and correction of these hemodynamic disorders are needed.
Collapse
Affiliation(s)
- Muhamed Djedovic
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amel Hadzimehmedagic
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nedzad Rustempasic
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | |
Collapse
|
6
|
Meyer A, Gall C, Verdenhalven J, Lang W, Almasi-Sperling V, Behrendt CA, Guenther J, Rother U. Influence of Eversion Endarterectomy and Patch Reconstruction on Postoperative Blood Pressure After Carotid Surgery. Ann Vasc Surg 2021; 78:61-69. [PMID: 34464726 DOI: 10.1016/j.avsg.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/17/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Post carotid blood pressure fluctuation and hypertension (PEH) are associated with increased risk for adverse outcome; there is limited evidence on the impact of eversion endarterectomy (E-CEA) versus conventional endarterectomy with patch closure (C-CEA) on postoperative blood pressure course. PATIENTS AND METHODS In this retrospective observational study, 859 consecutive carotid endarterectomy procedures between 2004 and 2014 (C-CEA n = 585 vs. E-CEA n = 274), were evaluated. Pre- and postoperative blood pressure values were recorded from recovery room until third postoperative day and compared between both techniques; influences on the dichotomous target variable "at least one postoperative blood pressure peak", that is need for postoperative vasodilators, were analyzed by a logistic regression model. Influences on postoperative systolic blood pressure were evaluated by a linear mixed effects regression model. RESULTS Preoperative baseline blood pressure was not different between both comparison groups. During postoperative course, significantly increased mean systolic blood pressure values in the E-CEA group from recovery room to second postoperative day (recovery room C-CEA: 129.2 mm Hg vs. E-CEA: 136.5 mm Hg; P < 0.001; first postoperative day C-CEA: 132.4 mm Hg vs. E-CEA: 139.3 mm Hg; P = 0.0002; second postoperative day C-CEA: 138.6 mm Hg vs. E-CEA: 143.1 mm Hg; P = 0.023) were observed. No hyperperfusion syndrome was detected as wells as no difference in postoperative complication rate. Frequency of antihypertensive interventions was also elevated in E-CEA group (C-CEA 22.1 % vs. E-CEA 31.8 %; P = 0.003). E-CEA (OR 1.591, 95% CI [1.146; 2.202]; P = 0.005) and presence of preoperatively elevated systolic readings (OR 1.015, 95%CI [1.006;1.024]; P < 0.001) was also associated with increased need for antihypertensive interventions. CONCLUSION E-CEA was associated with significantly elevated postoperative blood pressure, compared to C-CEA. C-CEA was associated with postoperative blood pressure decrease; however, no difference as to neurologic and surgical complications was detected between both surgical techniques in clinical practice.
Collapse
Affiliation(s)
- Alexander Meyer
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany.
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julia Verdenhalven
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Josefine Guenther
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
7
|
Pitchai S, Kumar V, Ramachandran S, Sylaja PN. Alpha blocker – A better antihypertensive option for postendarterectomy hypertension. Indian J Vasc Endovasc Surg 2021. [DOI: 10.4103/ijves.ijves_155_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
8
|
Ignatenko PV, Gostev AA, Novikova OA, Saaya SB, Rabtsun AA, Popova IV, Cheban AV, Zeidlitz GA, Klevanets YЕ, Starodubtsev VB, Karpenko AА. Hemodynamic changes in different types of carotid endarterectomy in the short- and long-term postoperative periods in patients with carotid artery stenosis. Cardiovasc Ther Prev 2020. [DOI: 10.15829/1728-8800-2020-2381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
9
|
Teng L, Fang J, Zhang Y, Liu X, Qu C, Shen C. Perioperative baseline β-blockers: An independent protective factor for post-carotid endarterectomy hypertension. Vascular 2020; 29:270-279. [PMID: 32772840 DOI: 10.1177/1708538120946538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Post-carotid endarterectomy hypertension is a well-recognized phenomenon closely related to surgical complications. This study aimed to determine whether different kinds of perioperative antihypertensive drugs had a protective effect on post-carotid endarterectomy hypertension and influence on intraoperative hemodynamics. METHOD We retrospectively investigated 102 carotid stenosis patients who underwent conventional endarterectomy with a perioperative baseline antihypertensive regimen. Post-carotid endarterectomy hypertension was defined as a postoperative peak systolic blood pressure ≥160 mmHg and/or a requirement for any additional antihypertensive therapies. We compared the clinical characteristics and types of baseline perioperative antihypertensive drugs between patients with and without post-carotid endarterectomy hypertension and then determined the significant independent effect of antihypertensive drugs on post-carotid endarterectomy hypertension through multivariate regression and detected their influence on intraoperative hypertension (induction-related systolic blood pressure and vasodilators consumption) and hemodynamic depression (intra-arterial systolic blood pressure ≤100 mmHg and/or heart rate ≤50 beats/min). We also investigated adverse events such as stroke, death, myocardial infarction, and cerebral hyperperfusion syndrome during the postoperative hospitalization. RESULTS A total of 52/102 (51.0%) patients were defined as having post-carotid endarterectomy hypertension during the first three days postoperative, including eight patients with a postoperative systolic blood pressure that exceeded 160 mmHg at least once, 31 patients requiring postoperative antihypertensive treatment in addition to their baseline regimen, and 13 patients with both. The incidence of stroke/death/myocardial infarction and cerebral hyperperfusion syndrome after conventional endarterectomy during hospitalization were both 1.9%. A significantly increased risk of composite postoperative complications (including cerebral hyperperfusion syndrome, hyperperfusion-related symptoms, transient ischemic attacks, stroke, death, and cardiac complications) was observed in patients with post-carotid endarterectomy hypertension than without (15.4% versus 2.0%, p = 0.032). Patients free of post-carotid endarterectomy hypertension had a higher incidence of perioperative baseline β-blocker use than patients who suffered from post-carotid endarterectomy hypertension (46.0% versus 21%, p = 0.008). In multivariate analysis, β-blocker use was a significant independent protective factor for post-carotid endarterectomy hypertension (OR = 0.356, 95% CI: 0.146-0.886, p = 0.028). Patients taking β-blockers had a lower postoperative peak systolic blood pressure than the β-blocker-naïve population (137.1 ± 12.1 mmHg versus 145.0 ± 11.2 mmHg, p = 0.008), but the postoperative mean systolic blood pressure showed no intergroup difference. However, the incidence of hemodynamic depression during conventional endarterectomy was higher in patients with perioperative β-blocker use than in those without (44.1% versus 25.0%, p = 0.050). The difference in intraoperative hemodynamic depression became more prominent between the β-blocker and non-β-blocker groups (81.8% versus 33.3%, p = 0.014) for whose preoperative baseline heart rate was equal to or lower than 70 beats/min. CONCLUSION The perioperative use of β-blockers is a protective factor for post-carotid endarterectomy hypertension and contributes to stabilizing the postoperative peak systolic blood pressure three days after conventional endarterectomy. However, β-blockers might also lead to intraoperative hemodynamic depression, especially for patients with a low baseline heart rate.
Collapse
Affiliation(s)
- Lequn Teng
- National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Fang
- National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
| | - Yongbao Zhang
- National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
| | - Xinnong Liu
- National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
| | - Chengjia Qu
- National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chenyang Shen
- National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
| |
Collapse
|
10
|
Tan J, Wang Q, Shi W, Liang K, Yu B, Mao Q. A Machine Learning Approach for Predicting Early Phase Postoperative Hypertension in Patients Undergoing Carotid Endarterectomy. Ann Vasc Surg 2020; 71:121-131. [PMID: 32653616 DOI: 10.1016/j.avsg.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 07/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to establish and validate a machine learning-based model for the prediction of early phase postoperative hypertension (EPOH) requiring the administration of intravenous vasodilators after carotid endarterectomy (CEA). METHODS Perioperative data from consecutive CEA procedures performed from January 2013 to August 2019 were retrospectively collected. EPOH was defined in post-CEA patients as hypertension involving a systolic blood pressure above 160 mm Hg and requiring the administration of any intravenous vasodilator medications in the first 24 hr after a return to the vascular ward. Gradient boosted regression trees were used to construct the predictive model, and the featured importance scores were generated by using each feature's contribution to each tree in the model. To evaluate the model performance, the area under the receiver operating characteristic curve was used as the main metric. Four-fold stratified cross-validation was performed on the data set, and the average performance of the 4 folds was reported as the final model performance. RESULTS A total of 406 CEA operations were performed under general anesthesia. Fifty-three patients (13.1%) met the definition of EPOH. There was no significant difference in the percentage of postoperative stroke/death between patients with and without EPOH during the hospital stay. Patients with EPOH exhibited a higher incidence of postoperative cerebral hyperperfusion syndrome (7.5% vs. 0, P < 0.001), as well as a higher incidence of cerebral hemorrhage (3.8% vs. 0, P < 0.001). The gradient boosted regression trees prediction model achieved an average AUC of 0.77 (95% CI 0.62 to 0.92). When the sensitivity was fixed near 0.90, the model achieved an average specificity of 0.52 (95% CI 0.28 to 0.75). CONCLUSIONS We have built the first-ever machine learning-based prediction model for EPOH after CEA. The validation result from our single-center database was very promising. This novel prediction model has the potential to help vascular surgeons identify high-risk patients and reduce related complications more efficiently.
Collapse
Affiliation(s)
- Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Wang
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kun Liang
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Yu
- Department of Vascular Surgery, Pudong Hospital, Fudan University, Shanghai, China.
| | | |
Collapse
|
11
|
Deşer SB, Demirag MK, Kolbakir F. Does surgical technique influence the postoperative hemodynamic disturbances and neurological outcomes in carotid endarterectomy? Acta Chir Belg 2019; 119:78-82. [PMID: 29701500 DOI: 10.1080/00015458.2018.1459364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The carotid endarterectomy is already well established in patients with symptomatic or asymptomatic internal carotid artery (ICA) stenosis. The aim of this study was to determine whether there is a difference in postoperative blood pressure changes, stroke rate and postoperative complications following eversion carotid endarterectomy (E-CEA) and conventional carotid endarterectomy (C-CEA). METHODS From 1 January 2010 to 31 March 2017 consecutive patients admitted to our department with symptomatic or asymptomatic ICA stenosis were included in this retrospective study. During the 7-year period, 175 CEAs were performed in 166 consecutive patients (25 females, 141 males; mean age 70.6 ± 14.4 years; range 47 to 92 years). RESULTS The mean operative and cross-clamping time were shorter for E-CEA (72 ± 14.3 minutes vs. 115 ± 17.4 minutes, p < .001), (22 ± 7.7 vs 34 ± 6.3, p < .001) respectively. No significant difference was noted between the groups for the occurrence of perioperative stroke (p = .501). No significant difference was noted for postoperative blood pressure difference on the 6th hour and the 24th hour after surgery between E-CEA and C-CEA (p = .130). CONCLUSIONS E-CEA was associated with significant reduction in operative time and cross-clamping time however, increases postoperative bleeding. No difference was noted for postoperative stroke and blood pressure distortion between E-CEA and C-CEA.
Collapse
Affiliation(s)
- Serkan Burç Deşer
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Mustafa Kemal Demirag
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fersat Kolbakir
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| |
Collapse
|
12
|
Inaraja-pérez G, Júlvez-blancas M. Usefulness of the Clavien-Dindo Classification to Rate Complications after Carotid Endarterectomy and Its Implications in Patient Prognosis. Ann Vasc Surg 2019; 55:232-8. [DOI: 10.1016/j.avsg.2018.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/16/2018] [Accepted: 06/28/2018] [Indexed: 11/17/2022]
|
13
|
Ignatenko P, Novikova O, Gostev A, Starodubtsev V, Zeidlits G, Kuznetsov K, Starodubtseva A, Karpenko A. Carotid Endarterectomy with Autoarterial Remodeling of Bifurcation of the Common Carotid Artery and Carotid Endarterectomy with Patch Closure: Comparison of Methods. J Stroke Cerebrovasc Dis 2019; 28:741-50. [PMID: 30545718 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/05/2018] [Accepted: 11/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The objectives of our research were to identify whether the new method of carotid endarterectomy (CEA) with autoarterial remodeling of bifurcation of the common carotid artery (ARBCCA) influences daily parameters of blood pressure and heart rate (HR) while monitoring them on a daily basis and to assess the efficacy of the suggested method. MATERIALS AND METHODS It is a prospective randomized comparative study. The first group (n = 100) included patients that underwent ARBCCA, the second group (n = 100) included patients that underwent "classic" CEA with xenopericardial patch closure. Diurnal Holter recording of blood pressure and (HR) was performed before and after the surgical treatment in both groups. RESULTS Surgical treatment in both groups leads to an increase of HR, arterial hypertension time index by systolic blood pressure, and arterial hypertension time index by diastolic arterial blood pressure. The damage of carotid artery bulb increases sympathetic innervation and causes dysregulation of the baroreceptor mechanism. CONCLUSIONS In our study, we did not reveal a significant difference in the incidence of postoperative hypertension and the dependence of HR on the choice of surgical technique. Thus, the proposed ARBCCA method does not lead to an increased risk of pre-existing arterial hypertension development. A significant difference is found out on the parameter of the clamping time of carotid arteries in favor to ARBCCA group. Another advantage of the suggested technique is the number of restenosis greater than 50% during the 2-year follow-up (4 [4%] cases (ARBCCA group) versus 12 [12%] cases ["classic" CEA], respectively, P = .037).
Collapse
|
14
|
Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, Hamilton G, Kakisis J, Kakkos S, Lepidi S, Markus HS, McCabe DJ, Roy J, Sillesen H, van den Berg JC, Vermassen F, Kolh P, Chakfe N, Hinchliffe RJ, Koncar I, Lindholt JS, Vega de Ceniga M, Verzini F, Archie J, Bellmunt S, Chaudhuri A, Koelemay M, Lindahl AK, Padberg F, Venermo M. Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:3-81. [PMID: 28851594 DOI: 10.1016/j.ejvs.2017.06.021] [Citation(s) in RCA: 785] [Impact Index Per Article: 130.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
15
|
Celi de la Torre JA, Skrypnik DA, Vinogradov RA, Böckler D, Demirel S. [Postoperative blood pressure alterations after carotid endarterectomy : Implications of different reconstruction methods]. Chirurg 2018; 89:123-30. [PMID: 28842735 DOI: 10.1007/s00104-017-0502-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative blood pressure alterations after carotid endarterectomy (CEA) are associated with an increased risk of morbidity and mortality. OBJECTIVE To outline the influence of the two commonly used surgical reconstruction techniques, conventional CEA with patch plasty (C-CEA) and eversion CEA (E-CEA), as well as the innovative carotid sinus-preserving eversion CEA (SP-E-CEA) technique on postoperative hemodynamics, taking the current scientific knowledge into consideration. METHODS Assessment of the current clinical and scientific evidence on each operative technique found in the PubMed (NLM) database ranging from 1974 to 2017, excluding case reports. RESULTS A total of 34 relevant papers as well as 1 meta-analysis, which scientifically dealt with the described topic were identified. The results of the studies and the meta-analysis showed that E‑CEA correlates with an impairment of local baroreceptor functions as well as with an elevated need for vasodilators in the early postoperative phase, whereas C‑CEA and SP-E-CEA seem to have a more favorable effect on the postoperative blood pressure. CONCLUSION The CEA technique influences the postoperative blood pressure regulation, irrespective of the operative technique used. Accordingly, close blood pressure monitoring is recommended at least during the postoperative hospital stay. Further studies are mandatory to evaluate the importance of SP-E-CEA as an alternative to the classical E‑CEA.
Collapse
|
16
|
Newman JE, Bown MJ, Sayers RD, Thompson JP, Robinson TG, Williams B, Panerai R, Lacy P, Naylor AR. Post-Carotid Endarterectomy Hypertension. Part 1: Association with Pre-operative Clinical, Imaging, and Physiological Parameters. Eur J Vasc Endovasc Surg 2017; 54:551-63. [PMID: 28268070 DOI: 10.1016/j.ejvs.2017.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/24/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Post-endarterectomy hypertension (PEH) is a well recognised, but poorly understood, phenomenon after carotid endarterectomy (CEA) that is associated with post-operative intracranial haemorrhage, hyperperfusion syndrome, and cardiac complications. The aim of the current study was to identify pre-operative clinical, imaging, and physiological parameters associated with PEH. METHODS In total, 106 CEA patients undergoing CEA under general anaesthesia underwent pre-operative evaluation of 24 hour ambulatory arterial blood pressure (BP), baroreceptor sensitivity, cerebral autoregulation, and transcranial Doppler measurement of cerebral blood flow velocity (CBFv) and pulsatility index. Patients who met pre-existing criteria for treating PEH after CEA (systolic BP [SBP] > 170 mmHg without symptoms or SBP > 160 mmHg with headache/seizure/neurological deficit) were treated according to a previously established protocol. RESULTS In total, 40/106 patients (38%) required treatment for PEH at some stage following CEA (26 in theatre recovery [25%], 27 while on the vascular surgical ward [25%]), while seven (7%) had SBP surges > 200 mmHg back on the ward. Patients requiring treatment for PEH had a significantly higher pre-operative SBP (144 ± 11 mmHg vs. 135 ± 13 mmHg; p < .001) and evidence of pre-existing impairment of baroreceptor sensitivity (3.4 ± 1.7 ms/mmHg vs. 5.3 ± 2.8 ms/mmHg; p = .02). However, PEH was not associated with any other pre-operative clinical features, CBFv, or impaired cerebral haemodynamics. Paradoxically, autoregulation was better preserved in patients with PEH. All four cases of hyperperfusion associated symptoms were preceded by PEH. Length of hospital stay was significantly increased in patients with PEH (p < .001). CONCLUSION In this study, where all patients underwent CEA under general anaesthesia, PEH was associated with poorly controlled pre-operative BP and impaired baroreceptor sensitivity, but not with other peripheral or central haemodynamic parameters, including impaired cerebral autoregulation.
Collapse
|
17
|
Demirel S, Goossen K, Bruijnen H, Probst P, Böckler D. Systematic review and meta-analysis of postcarotid endarterectomy hypertension after eversion versus conventional carotid endarterectomy. J Vasc Surg 2017; 65:868-882. [DOI: 10.1016/j.jvs.2016.10.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
|
18
|
Hosn MA, Adams B, Pederson M, Kresowik T, Pascarella L. Long-Term Effect of the Type of Carotid Endarterectomy on Blood Pressure. Ann Vasc Surg 2016; 39:204-208. [PMID: 27554699 DOI: 10.1016/j.avsg.2016.05.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/11/2016] [Accepted: 05/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The dissection of the carotid sinus nerve in eversion carotid endarterectomy (eCEA) has been hypothesized to cause an increase in postoperative blood pressure (BP). The objective of this study is to evaluate the effect of eCEA on BP and changes in BP medications over the course of year-long follow-up after eCEA compared with longitudinal incision carotid endarterectomy patch angioplasty (pCEA). METHODS A retrospective review of patients who underwent CEA between July 1, 2009 and June 30, 2014 in the Vascular Surgery Department at The University of Iowa Hospital and Clinics was conducted. Demographics, comorbidities, BP, and number, dosage, and type of antihypertensive medications were collected preoperatively, at 30 days, and at 12 months. The differences in BP and medications between pCEA and eCEA patients were compared. Demographic data and comorbidities were compared using t-tests and chi-squared analysis. Differences in BP and medication dosages were analyzed using multivariate analysis of variance. RESULTS In total, 363 CEA procedures were performed during the study period, of which 275 procedures were included in the final analysis. Thirty percent of the patients underwent eCEA. Fifty-four percent of the patients who underwent eCEA and 60% of the patients who underwent pCEA were symptomatic. Thirty-day mortality was 1.4% and 12-month mortality was 6.4% for the entire population. No postoperative neurologic deficits, including stroke, were observed. Analysis of BP did not yield a significant difference among preoperative, 30-day, and 12-month follow-up measurements (P = 0.893). There was no significant change to the number and total daily dose of BP medications preoperatively, at 30 days, or at 12 months. CONCLUSIONS There is no statistical difference in mortality, morbidity, and patency rates at 30 days and 12 months between pCEA and eCEA. eCEA is also not associated with long-term BP changes compared with pCEA.
Collapse
Affiliation(s)
- Maen Aboul Hosn
- Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Brian Adams
- Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Mark Pederson
- Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Timothy Kresowik
- Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Luigi Pascarella
- Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
19
|
Ben Ahmed S, Daniel G, Benezit M, Bailly P, Aublet-Cuvelier B, Mulliez A, Ribal JP, Rosset E. Does the Technique of Carotid Endarterectomy Determine Postoperative Hypertension? Ann Vasc Surg 2015; 29:1272-80. [DOI: 10.1016/j.avsg.2015.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/22/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
|
20
|
Affiliation(s)
| | - Anneliese Moerman
- Department of Anesthesiology, University Hospital Ghent, Ghent, Belgium
| | - Stefan De Hert
- Department of Anesthesiology, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
21
|
Hoefer J, Pierer E, Rantner B, Stadlbauer KH, Fraedrich G, Fritz J, Kleinsasser A, Velik-Salchner C. Ultrasound-guided regional anesthesia for carotid endarterectomy induces early hemodynamic and stress hormone changes. J Vasc Surg 2015; 62:57-67. [DOI: 10.1016/j.jvs.2015.02.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/21/2015] [Indexed: 11/26/2022]
|
22
|
Cao Q, Zhang J, Xu G. Hemodynamic changes and baroreflex sensitivity associated with carotid endarterectomy and carotid artery stenting. Interv Neurol 2015; 3:13-21. [PMID: 25999987 DOI: 10.1159/000366231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Atherosclerotic carotid lesion is a major cause of stroke which accounts for up to 20% of ischemic stroke. Aggressive treatment of carotid stenosis may prevent stroke. Currently, carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the first-line treatments for severe carotid stenosis. CEA is superior to medical therapy in preventing stroke and cardiovascular death. CAS has emerged as an alternative to CEA in recent years due to its less invasive nature. However, both CEA and CAS may be associated with adverse hemodynamic changes as well as a variation of carotid baroreflex sensitivity. There is no consensus on which of these two methods is more advantageous concerning the procedure-related hemodynamic changes. This article reviews the hemodynamic changes and baroreflex sensitivity after CEA and CAS.
Collapse
Affiliation(s)
- Qinqin Cao
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jun Zhang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| |
Collapse
|
23
|
Demirel S, Attigah N, Bruijnen H, Wieker C, Böckler D. The role of atropine in carotid stenting of recurrent stenosis after eversion endarterectomy. J Vasc Surg 2015; 61:112-8. [DOI: 10.1016/j.jvs.2014.06.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
|
24
|
Taurino M, Filippi F, Persiani F, Tirotti C, Dito R, Brancadoro D, Rizzo L. Hemodynamic Changes in Chevalier Eversion Versus Conventional Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2014; 48:514-20. [DOI: 10.1016/j.ejvs.2014.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 08/01/2014] [Indexed: 12/27/2022]
|
25
|
Linni K, Aspalter M, Neureiter D, Hitzl W, Magometschnigg H, Hölzenbein T. Postoperative blood pressure in patients undergoing eversion carotid endarterectomy with or without resection of the carotid sinus nerve. Eur Surg 2014. [DOI: 10.1007/s10353-014-0267-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
26
|
Linni K, Aspalter M, Metzger P, Magometschnigg H, Hölzenbein T. Management of atherosclerotic supraaortic lesions. Eur Surg 2014; 46:250-9. [DOI: 10.1007/s10353-014-0268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
Yasa H, Akyuz M, Yakut N, Aslan O, Akyuz D, Ozcem B, Tulukoğlu E, Gurbuz A. Comparison of two surgical techniques for carotid endarterectomy: conventional and eversion. Neurochirurgie 2014; 60:33-7. [PMID: 24673880 DOI: 10.1016/j.neuchi.2013.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 11/06/2013] [Accepted: 12/08/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of carotid endarterectomy for the treatment of atherosclerotic carotid bifurcation disease is now well established. The aim of this study was to compare durability, postoperative death, stroke, minor strokes, cranial nerve injuries, neck hematomas, myocardial infarctions, or surgical defects and restenosis at the operative site following short- and mid-term duration of the advantages eversion carotid endarterectomy (E-CEA) compared to conventional carotid endarterectomy (C-CEA). PATIENTS AND METHODS Between March 2003 and November 2012, primary CEAs were performed in 380 consecutive patients by the same surgical groups. These patients were evaluated retrospectively. C-CEA was performed in 202 patients, and E-CEA was performed in 178 patients. Carotid duplex ultrasonography was performed in all patients at 1, 6, 12 and 24 months after CEA to identify residual atherosclerotic carotid disease. RESULTS Mean age was 67.3±13.4 years in the E-CEA group and 64.8±14.8 years in the C-CEA group. Mean cross-clamping time in the E-CEA group was 9.54±2.6 minutes and 12.62±2.7 minutes for C-CEA group (P=0.236). Three postoperative strokes occurred (one after E-CEA and two after C-CEA). In the E-CEA group and C-CEA group respectively, carotid stenosis rates were found in 4 patients (2.24%) and in 5 (2.97%) at a follow-up period of 26 months. CONCLUSION Classical endarterectomy still remains the gold standard surgical technique for patients who are selected for coronary artery disease surgery. Nevertheless, we believe that eversion endarterectomy, which has some advantages, must be kept in mind as an alternative approach.
Collapse
Affiliation(s)
- H Yasa
- Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
| | - M Akyuz
- Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
| | - N Yakut
- Special Akut Cardiovascular Surgical Hospital, Izmir, Turkey.
| | - O Aslan
- Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
| | - D Akyuz
- Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
| | - B Ozcem
- Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
| | - E Tulukoğlu
- Special Akut Cardiovascular Surgical Hospital, Izmir, Turkey.
| | - A Gurbuz
- Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
| |
Collapse
|
28
|
Saadeh C, Sfeir J. Discontinuation of preoperative clopidogrel is unnecessary in peripheral arterial surgery. J Vasc Surg 2013; 58:1586-92. [DOI: 10.1016/j.jvs.2013.05.092] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/14/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
|
29
|
Tan TW, Eslami MH, Kalish JA, Eberhardt RT, Doros G, Goodney PP, Cronenwett JL, Farber A. The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality. J Vasc Surg 2013; 59:16-24.e1-2. [PMID: 23994095 DOI: 10.1016/j.jvs.2013.07.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/11/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the outcomes of patients after carotid endarterectomy (CEA) who developed postoperative hypertension or hypotension requiring the administration of intravenous vasoactive medication (IVMED). METHODS We examined consecutive, primary elective CEA performed by 128 surgeons within the Vascular Study Group of New England (VSGNE) database (2003-2010) and compared outcomes of patients who required postoperative IVMED to treat hyper- or hypotension with those who did not. Outcomes included perioperative death, stroke, myocardial infarction (MI), congestive heart failure (CHF), hospital length of stay, and 1-year stroke or death. Propensity score matching was performed to facilitate risk-adjusted comparisons. Multivariable regression models were used to compare the association between IVMED and outcomes in unmatched and matched samples. Factors associated with use of IVMED in postoperative hypertension and hypotension were evaluated, and predictive performance of multivariable models was examined using receiver operating characteristic (ROC) curves. RESULTS Of 7677 elective CEAs identified, 23% received IVMED for treatment of either postoperative hypertension (11%) or hypotension (12%). Preoperative neurological symptomatic status (20%) was similar across cohorts. In the crude sample, the use of IVMED to treat postoperative hypertension was associated with increased 30-day mortality (0.7% vs 0.1%; P < .001), stroke (1.9% vs 1%; P = .018), MI (2.4% vs 0.5%; P < .001), and CHF (1.9% vs 0.5%; P < .001). The use of IVMED to treat postoperative hypotension was also associated with increased perioperative mortality (0.8% vs 0.1%; P < .001), stroke (3.2% vs 1.0%; P < .001), MI (2.7% vs 0.5%; P < .001), and CHF (1.7% vs 0.5%; P < .001), as well as 1-year death (5.1% vs 2.9%; P < .001) or stroke (4.2% vs 2.1%; P < .001). Hospital length of stay was significantly longer among patients who needed IVMED for postoperative hypertension (2.8 ± 4.7 days vs 1.7 ± 5.5 days; P < .001) and hypotension (2.8 ± 5.9 days vs 1.7 ± 5.5 days; P < .001). In multivariable analysis, IVMED for postoperative hypertension was associated with increased MI, stroke, or death (odds ratio, 2.6; 95% confidence interval [CI], 1.6-4.1; P < .001). Similarly, IVMED for postoperative hypotension was associated with increased MI, stroke, or death (odds ratio, 3.2; 95% CI, 2.1-5.0; P < .001), as well as increased 1-year stroke or death (hazard ratio, 1.6; 95% CI, 1.2-2.2; P = .003). Smoking, coronary artery disease, and clopidogrel (ROC, 0.59) were associated with postoperative hypertension requiring IVMED, whereas conventional endarterectomy and general anesthesia were associated with postoperative hypotension requiring IVMED (ROC, 0.58). The unitization of IVMED varied between 11% and 38% across VSGNE, and center effect did not affect outcomes. CONCLUSIONS Postoperative hypertension requiring IVMED after CEA is associated with increased perioperative mortality, stroke, and cardiac complications, whereas significant postoperative hypotension is associated with increased perioperative mortality, cardiac, or stroke complications, as well as increased 1-year death or stroke following CEA. The utilization of IVMED varied across centers and, as such, further investigation into this practice needs to occur in order to improve outcomes of these at-risk patients.
Collapse
Affiliation(s)
- Tze-Woei Tan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, Shreveport, La.
| | - Mohammad H Eslami
- Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass
| | - Jeffrey A Kalish
- Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass
| | - Robert T Eberhardt
- Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass
| | - Gheorghe Doros
- Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass
| | - Philip P Goodney
- Section of Vascular Surgery, Darthmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jack L Cronenwett
- Section of Vascular Surgery, Darthmouth-Hitchcock Medical Center, Lebanon, NH
| | - Alik Farber
- Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass
| | | |
Collapse
|
30
|
Marrocco-Trischitta MM, Cremona G, Lucini D, Natali-Sora MG, Cursi M, Cianflone D, Pagani M, Chiesa R. Peripheral baroreflex and chemoreflex function after eversion carotid endarterectomy. J Vasc Surg 2013; 58:136-44.e1. [DOI: 10.1016/j.jvs.2012.11.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/20/2012] [Accepted: 11/25/2012] [Indexed: 12/19/2022]
|
31
|
Demirel S, Attigah N, Bruijnen H, Hakimi M, Burgmer B, Böckler D. Perioperative blood pressure alterations after eversion and conventional carotid endarterectomy sustain in the midterm. Langenbecks Arch Surg 2013; 398:303-12. [DOI: 10.1007/s00423-013-1048-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
|
32
|
Demirel S, Macek L, Attigah N, Bruijnen H, Hakimi M, Able T, Böckler D. Comparison of renin and catecholamine release in patients undergoing eversion or conventional carotid endarterectomy. J Vasc Surg 2012; 56:324-33. [DOI: 10.1016/j.jvs.2012.01.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 01/13/2012] [Accepted: 01/15/2012] [Indexed: 11/15/2022]
|
33
|
Demirel S, Macek L, Bruijnen H, Hakimi M, Böckler D, Attigah N. Eversion Carotid Endarterectomy is Associated with Decreased Baroreceptor Sensitivity Compared to the Conventional Technique. Eur J Vasc Endovasc Surg 2012; 44:1-8. [DOI: 10.1016/j.ejvs.2012.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
|
34
|
Demirel S, Attigah N, Bruijnen H, Hakimi M, Macek L, Böckler D. Eversion carotid endarterectomy is associated with impaired postoperative hemodynamic stability compared with the conventional technique. Ann Vasc Surg 2012; 26:755-65. [PMID: 22728106 DOI: 10.1016/j.avsg.2011.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/30/2011] [Accepted: 12/08/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Carotid endarterectomy is associated with a profound effect on blood pressure. The aim of this study was to evaluate 24-hour ambulatory blood pressure measurements (ABPMs) after eversion carotid endarterectomy (E-CEA) and conventional carotid endarterectomy (C-CEA). METHODS Seventy-one patients were included in this prospective study (E-CEA [37]/C-CEA [34]). Daytime (8 AM-10 PM) and nighttime (10 PM-8 AM) ABPMs were analyzed preoperatively and on postoperative days 1 and 3. RESULTS Patients' demographics and preoperative antihypertensive regimens were similar in the two groups. Compared with baseline, ABPM decreased on postoperative day 1 in the C-CEA group (P < 0.01) but normalized by day 3. By contrast, ABPM values were unchanged on day 1 in the E-CEA group but increased above baseline on day 3 (P < 0.01). E-CEA was associated with higher ABPM on day 1 (daytime: P < 0.001; nighttime: P < 0.01) and again on day 3 (daytime: P < 0.001; nighttime: P < 0.01). The use of vasodilators was more frequent in the E-CEA group, both in the recovery room (P = 0.007) and on the ward (P = 0.004). CONCLUSION E-CEA may be associated with higher postoperative blood pressure and the need for more additional antihypertensive therapy in the postoperative period compared with C-CEA.
Collapse
|
35
|
Demirel S, Attigah N, Bruijnen H, Macek L, Hakimi M, Able T, Böckler D. Changes in baroreceptor sensitivity after eversion carotid endarterectomy. J Vasc Surg 2012; 55:1322-8. [DOI: 10.1016/j.jvs.2011.11.134] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/21/2011] [Accepted: 11/28/2011] [Indexed: 11/30/2022]
|
36
|
Park JY, Kwun WH, Suh BY. The Results of Eversion Endarterectomy for Carotid Artery Stenosis. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jeong-Yeong Park
- Department of Suregry, Yeungnam University College of Medicine, Daegu, Korea
| | - Woo-Hyung Kwun
- Department of Suregry, Yeungnam University College of Medicine, Daegu, Korea
| | - Bo-Yang Suh
- Department of Suregry, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
37
|
Antonopoulos C, Kakisis J, Sergentanis T, Liapis C. Eversion versus Conventional Carotid Endarterectomy: A Meta-analysis of Randomised and Non-randomised Studies. Eur J Vasc Endovasc Surg 2011; 42:751-65. [DOI: 10.1016/j.ejvs.2011.08.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
|
38
|
Baracchini C, Gruppo M, Mazzalai F, Lorenzetti R, Meneghetti G, Ballotta E. Predictors of neck bleeding after eversion carotid endarterectomy. J Vasc Surg 2011; 54:699-705. [PMID: 21684710 DOI: 10.1016/j.jvs.2011.03.262] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to identify predictors for neck bleeding after eversion carotid endarterectomy (eCEA). METHODS A prospectively compiled computerized database of all primary eCEAs performed at a tertiary referral center between September 1998 and December 2009 was analyzed. The end point was any neck bleeding after eCEA. End point predictors were identified by univariate analysis. RESULTS Of 1458 eCEAs performed by the same surgeon on 1294 patients under general anesthesia with continuous electroencephalographic monitoring and selective shunting, there were five major and three minor perioperative strokes (0.5%), and no deaths. Neck bleeding after eCEA occurred in 120 cases (8.2%), of which 69 (4.7%) needed re-exploration. Univariate analysis (odds ratio [95% confidence interval]) identified preoperative antiplatelet treatment with clopidogrel (1.77 [1.20-2.62], P = .004), particularly when continued to the day before CEA (3.84 [2.01-7.33], P < .001), and postoperative hypertension (9.44 [6.34-14.06], P < .001) as risk factors for neck bleeding in general and for neck bleeding requiring re-exploration (4.50 [1.85-10.89], P = .001; 15.27 [2.08-104.43], P = .006, and 2.44 [1.12-5.30], P = .02, respectively). An increased risk of neck bleeding in general was associated with clopidogrel plus acetylsalicylic acid (12.00 [2.59-56.78], P = .005), acetylsalicylic acid alone (4.37 [1.99-9.57], P < .001), and ticlopidine (2.49 [1.10-5.63], P = .02) only when they were continued to the day before CEA. No neck bleeding was associated with preoperative treatment with dipyridamole or warfarin, or no medication. No further complications occurred in the patients who underwent re-exploration. CONCLUSIONS The results of this single-center university hospital study show that neck bleeding after CEA is relatively common but is not associated with an increased risk of stroke or death. Preoperative treatment with clopidogrel, particularly when it is continued to the day before surgery, and postoperative arterial hypertension seem to be associated with a higher risk of neck bleeding after CEA, requiring re-exploration in most cases. Other antiplatelet agents appear to be associated with an increased risk of postoperative neck bleeding only if they are continued to the day before CEA. Larger studies are warranted to confirm our findings and prevent this feared surgical complication.
Collapse
Affiliation(s)
- Claudio Baracchini
- Department of Neurological Sciences, University of Padua, School of Medicine, Padova, Italy
| | | | | | | | | | | |
Collapse
|
39
|
Demirel S, Bruijnen H, Attigah N, Hakimi M, Böckler D. The effect of eversion and conventional-patch technique in carotid surgery on postoperative hypertension. J Vasc Surg 2011; 54:80-6. [DOI: 10.1016/j.jvs.2010.11.106] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/20/2010] [Accepted: 11/13/2010] [Indexed: 11/22/2022]
|
40
|
AbuRahma AF. Processes of care for carotid endarterectomy: Surgical and anesthesia considerations. J Vasc Surg 2009; 50:921-33. [DOI: 10.1016/j.jvs.2009.04.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/22/2009] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
|
41
|
|
42
|
|
43
|
Lin PH, Zhou W, Kougias P, El Sayed HF, Barshes NR, Huynh TT. Factors associated with hypotension and bradycardia after carotid angioplasty and stenting. J Vasc Surg 2007; 46:846-54. [DOI: 10.1016/j.jvs.2007.07.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 07/03/2007] [Indexed: 11/21/2022]
|
44
|
Abstract
Carotid endarterectomy (CEA) is performed to prevent embolic stroke in patients with atheromatous disease at the carotid bifurcation. There is now substantial evidence to support early operation in symptomatic patients, ideally within 2 weeks of the last neurological symptoms. Thus, the anaesthetist may be faced with a high risk patient in whom there has been limited time for preoperative preparation. The operation may be performed under local or general anaesthesia. The advantages and disadvantages of both are explored in this review. Carotid shunting may offer a degree of cerebral protection, but carries its own risks and has not been proved to reduce morbidity and mortality. The use of carotid shunts is based on clinical judgement, awake neurological monitoring, and the use of monitors of cerebral perfusion. There is no ideal monitor of cerebral perfusion in the patient receiving general anaesthesia. Both the intraoperative and postoperative periods may be witness to dramatic haemodynamic changes that may compromise the cerebral or myocardial circulations. In particular, postoperative hypotension may compromise both myocardial and cerebral perfusion, and severe hypertension can cause cerebral hyperperfusion. There is as yet limited evidence to guide the management of these problems. In summary, CEA can yield significant benefit, but those with the most to gain from the operation also present the greatest challenge to the anaesthetist.
Collapse
Affiliation(s)
- S J Howell
- Academic Unit of Anaesthesia, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
| |
Collapse
|
45
|
Wallenborn J, Thieme V, Hertel-Gilch G, Gräfe K, Richter O, Schaffranietz L. Effects of clonidine and superficial cervical plexus block on hemodynamic stability after carotid endarterectomy. J Cardiothorac Vasc Anesth 2007; 22:84-9. [PMID: 18249336 DOI: 10.1053/j.jvca.2007.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the effects of 2 interventions (intravenous clonidine and superficial cervical block) on hemodynamic stability after carotid endarterectomy and to identify variables associated with hemodynamic instability. DESIGN Prospective, observational study, sequential enrollment. SETTING University hospital. PARTICIPANTS Two hundred seventy-five patients undergoing elective carotid endarterectomy under general anesthesia. INTERVENTIONS Group NN (n = 50) received no intervention. In group CN (n = 85), 3 mug/kg of clonidine were administered intravenously 30 minutes before the end of the operation. Group CB (n = 140) additionally received a superficial cervical plexus block (SCB) with 20 mL of naropine 0.5% before the induction of anesthesia. MEASUREMENTS AND MAIN RESULTS Clonidine alone (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.45-3.76) and clonidine combined with an SCB (OR, 4.99; 95% CI, 3.19-7.82) resulted in a significant increase in hemodynamic stability after CEA (p < 0.001) from 53.3% (NN) to 70.0% (CN) and 83.3% (CB), respectively. The need for rescue medication decreased from 40.0% to 17.6% and 13.6% (p < 0.001). Both interventions significantly reduced the need for postoperative opioid analgesics (p < 0.01). Logistic regression analysis showed preoperative systolic blood pressure values greater than 170 mmHg (OR, 3.23; 95% CI, 1.76-5.93), previous cardiac interventions (OR, 3.3; 95% CI, 1.54-7.11), and the need for rescue medication in the awakening period (OR, 5.8; 95% CI, 2.88-11.52) to be independent risk factors for postoperative hemodynamic instability (p < or = 0.002). CONCLUSIONS Intravenous clonidine and superficial cervical block significantly improve cardiovascular stability after carotid endarterectomy. Patients with pre-existing excessive hypertension and previous coronary interventions must be considered a high-risk group.
Collapse
Affiliation(s)
- Jan Wallenborn
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
| | | | | | | | | | | |
Collapse
|
46
|
Nano G, Dalainas I, Bianchi P, Stegher S, Bet L, Malacrida G, Tealdi DG. Ballooning-induced bradycardia during carotid stenting in primary stenosis and restenosis. Neuroradiology 2006; 48:533-6. [PMID: 16670918 DOI: 10.1007/s00234-006-0096-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 03/23/2006] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We compared the incidence of intraprocedural bradycardia and hypotension during carotid artery stenting in patients with primary carotid artery stenosis and those with prior ipsilateral carotid endarterectomy. METHODS A total of 213 carotid stenting procedures were performed in our institution in a 4-year period. The mean degree of stenosis was 78% (range 60-99%). Of these 213 procedures, 43 were performed for carotid restenosis, 9 after stenting and 34 after endarterectomy, and 170 for primary stenosis. Atropine was selectively administrated if patients suffered bradycardia (a decrease in heart rate to <50% or an absolute heart rate of <40 bpm) or hypotension (systolic blood pressure <90 mmHg). We compared the group of patients with primary stenosis (n=170) and the group of patients with restenosis after carotid endarterectomy (n=34) in relation to intraprocedural hypotension or bradycardia/need for atropine administration. RESULTS Hypotension occurred in 49 patients with primary stenosis and 2 patients with restenosis. The difference was statistically significant. Atropine was administered for bradycardia to 58 patients with primary stenosis and 3 patients with restenosis. The difference was statistically significant. CONCLUSION Intraprocedural bradycardia and hypotension occur more frequently in patients with primary carotid artery stenosis.
Collapse
Affiliation(s)
- Giovanni Nano
- 1st Unit of Vascular Surgery, Istituto Policlinico San Donato, University of Milan, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
47
|
Cayne NS, Faries PL, Trocciola SM, Saltzberg SS, Dayal RD, Clair D, Rockman CB, Jacobowitz GR, Maldonado T, Adelman MA, Lamperello P, Riles TS, Kent KC. Carotid angioplasty and stent-induced bradycardia and hypotension: Impact of prophylactic atropine administration and prior carotid endarterectomy. J Vasc Surg 2005; 41:956-61. [PMID: 15944593 DOI: 10.1016/j.jvs.2005.02.038] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We compared the physiologic effect of selective atropine administration for bradycardia with routine prophylactic administration, before balloon inflation, during carotid angioplasty and stenting (CAS). We also compared the incidence of procedural bradycardia and hypotension for CAS in patients with primary stenosis vs those with prior ipsilateral carotid endarterectomy (CEA). METHODS A total of 86 patients were treated with CAS at 3 institutions. Complete periprocedural information was available for 75 of these patients. The median degree of stenosis was 90% (range, 60%-99%). Indications for CAS were severe comorbidities (n = 49), prior CEA (n = 21), and prior neck radiation (n = 5). Twenty patients with primary lesions were treated selectively with atropine only if symptomatic bradycardia occurred (nonprophylactic group). Thirty-four patients with primary lesions received routine prophylactic atropine administration before balloon inflation or stent deployment (prophylactic group). The 21 patients with prior CEA received selective atropine treatment only if symptomatic bradycardia occurred (prior CEA group) and were analyzed separately. Mean age and cardiac comorbidities did not vary significantly either between the prophylactic and nonprophylactic atropine groups or between the primary and prior CEA patient groups. Outcome measures included bradycardia (decrease in heart rate >50% or absolute heart rate <40 bpm), hypotension (systolic blood pressure <90 mm Hg or mean blood pressure <50 mm Hg), requirement for vasopressors, and cardiac morbidity (myocardial infarction or congestive heart failure). RESULTS The overall incidence of hypotension and bradycardia in patients treated with CAS was 25 (33%) of 75. A decreased incidence of intraoperative bradycardia (9% vs 50%; P < .001) and perioperative cardiac morbidity (0% vs 15%; P < .05) was observed in patients with primary stenosis who received prophylactic atropine as compared with patients who did not receive prophylactic atropine. CAS after prior CEA was associated with a significantly lower incidence of perioperative bradycardia (10% vs 33%; P < .05), hypotension (5% vs 32%; P < .05), and vasopressor requirement (5% vs 30%; P < .05), with a trend toward a lower incidence of cardiac morbidity (0% vs 6%; not significant) as compared with patients treated with CAS for primary carotid lesions. There were no significant predictive demographic factors for bradycardia and hypotension after CAS. CONCLUSIONS The administration of prophylactic atropine before balloon inflation during CAS decreases the incidence of intraoperative bradycardia and cardiac morbidity in primary CAS patients. Periprocedural bradycardia, hypotension, and the need for vasopressors occur more frequently with primary CAS than with redo CAS procedures. On the basis of our data, we recommend that prophylactic atropine administration be considered in patients with primary carotid lesions undergoing CAS.
Collapse
Affiliation(s)
- Neal S Cayne
- Department of Vascular Surgery, New York University Medical Center, NY 10016, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Affiliation(s)
- Rae Allain
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02214, USA
| | | | | | | |
Collapse
|
49
|
|
50
|
Mehta M, Veith FJ. Regarding "Hemodynamic benefits of regional anesthesia for carotid endarterectomy". J Vasc Surg 2003; 37:1134. [PMID: 12756368 DOI: 10.1067/mva.2003.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|