Eversion technique increases the risk for post-carotid endarterectomy hypertension

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Neurosurgery

Background:

• Carotid endarterectomy (CEA) is a common procedure to prevent stroke.
• Postoperative hypertension (HTN) is a known complication of CEA.
• Different CEA techniques may influence postoperative outcomes.

Purpose of the Study:

• To compare the incidence of postoperative hypertension (HTN) between eversion carotid endarterectomy (e-CEA) and standard carotid endarterectomy (s-CEA).

Main Methods:

• Retrospective analysis of 219 CEAs (137 s-CEA, 82 e-CEA) performed between January 1998 and January 2000.
• Patients had symptomatic or asymptomatic high-grade carotid artery stenosis.
• Outcomes assessed included postoperative hemodynamic instability, need for antihypertensive/vasopressor medications, stroke, and death.

Main Results:

• e-CEA was associated with significantly higher postoperative blood pressure (P <.005).
• More patients undergoing e-CEA required intravenous antihypertensive medication (24%) compared to s-CEA (6%).
• No significant difference in morbidity or mortality was observed between the two techniques.

Conclusions:

• Eversion carotid endarterectomy (e-CEA) is a significant risk factor for immediate postoperative hypertension.
• Vigilant diagnosis and management of HTN are essential for patients following e-CEA.
• The observed differences in HTN were more pronounced without the use of antihypertensive and vasopressor medications.