Blood pressure aberrations associated with carotid endarterectomy

This report examines and reviews the frequency, potential causes and management of blood pressure aberrations in 100 consecutive carotid thromboendarterectomies. Reasons for operation and postoperative sequelae included: asymptomatic stenosis, transient ischemic attacks, non-hemispheric symptoms, amaurosis fugax, previous stroke, and evolving stroke. Hypertension (greater than or equal to 100 mmHg diastolic) occurred within 24 hours of operation in 37 instances (37%). Recognized causes included: manifestation of preoperative hypertension (19); carotid sinus denervation or transient mild cerebral edema (16); and massive cerebral edema in the two postoperative strokes of the series. Control of hypertension was most commonly managed by intravenous administration of nitroprusside. Profound immediate hypotension and bradycardia occurred in association with six procedures (6%). Accelerated carotid sinus nerve activity after removal of the noncompliant plaque was the probable cause of this reflex. Management included intravenous administration of parasympatholytic (atropine) and sympathomimetic (epinephrine) drugs. Aberrations of blood pressure after carotid TEA are common but with proper management do not represent a risk factor for perioperative stroke.