No Evidence for Long Term Blood Pressure Differences Between Eversion and Conventional Carotid Endarterectomy in Two
Janis M Nolde1, Suk F Cheng2, Toby Richards3
1Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit / Royal Perth Hospital Medical Research Foundation, University of Western Australia, Perth, Australia.
Insights
Neither conventional nor eversion carotid endarterectomy (CEA) significantly alters long-term blood pressure (BP). Transecting the carotid sinus nerve during eversion CEA does not lead to clinically significant BP changes.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cardiology
Background:
- Blood pressure (BP) management is crucial for stroke prevention and care.
- Carotid endarterectomy (CEA) techniques may influence post-operative BP control.
- Eversion CEA routinely transects the carotid sinus nerve, unlike conventional CEA.
Purpose of the Study:
- To assess long-term blood pressure (BP) control after eversion and conventional carotid endarterectomy (CEA).
- To investigate the impact of carotid sinus nerve transection during eversion CEA on BP.
- To compare BP changes between conventional and eversion CEA techniques.
Main Methods:
- Analysis of patients from the International Carotid Stenting Study (ICSS) and UCL cohorts.
- Division of patients into eversion and conventional CEA groups.
- Mixed effect linear models used to assess BP changes over three years, adjusted for baseline data and antihypertensive treatment.
Main Results:
- No significant differences in long-term BP changes between eversion and conventional CEA.
- A mild, short-term BP lowering effect observed at discharge in the conventional CEA group (ICSS cohort) but not eversion CEA.
- No consistent BP alterations detected during follow-up for either technique.
Conclusions:
- Neither conventional nor eversion CEA results in clinically significant long-term BP changes.
- Concerns regarding BP alterations due to carotid sinus nerve transection in eversion CEA were not substantiated.
- Both CEA techniques appear safe concerning long-term blood pressure management.
Objective:
Blood pressure (BP) management is a vital aspect of stroke prevention and post-stroke care. Different surgical carotid endarterectomy (CEA) techniques may impact on BP control post-operatively. Specifically, the carotid sinus nerve, which innervates the carotid baroreceptors and carotid body, is commonly left intact during conventional CEA but is routinely transected as part of eversion CEA. The aim of this study was to assess long term BP control after eversion and conventional CEA.
Methods:
Patients from the International Carotid Stenting Study (ICSS cohort) and a personal series of patients from the Stroke Clinical Trials Unit at University College London (UCL cohort) were separately analysed and divided into eversion and conventional CEA groups. Mixed effect linear models were fitted and adjusted for baseline demographic data and antihypertensive treatment to test for changes in BP from baseline over a three year follow up period after the respective procedures.
Results:
There were no differences in changes in baseline BP readings and follow up readings between eversion and conventional CEA in the ICSS or UCL cohorts. In the ICSS cohort a mild but significant systolic (-8.6 mmHg; 95% confidence interval [CI] -10.6 - -6.6) and diastolic (-4.9 mmHg; 95% CI -6.0 - -3.8) BP lowering effect was evident at discharge in the conventional group but not in the eversion CEA group. BP monitoring during follow up did not reveal any consistent BP changes with either conventional or eversion CEA vs. baseline levels.
Conclusion:
Neither conventional nor eversion CEA seem to result in clinically significant long term BP changes. Potential concerns related to either short or long term alterations in BP levels with transection of the carotid sinus nerve during eversion CEA could not be substantiated.
Related Concept Videos
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:23Assessment of blood pressure in brachial artery(two-step method)
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure: