Related Experiment Videos
Blood pressure aberrations associated with carotid endarterectomy
1Division of Vascular Surgery Vanderbilt University Medical Center, Nashville, Tennessee 37232.
Insights
Blood pressure changes are common after carotid endarterectomy (TEA). However, these hypertension and hypotension events can be effectively managed, posing no increased risk for stroke.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid thromboendarterectomy (TEA) is a procedure to remove plaque from carotid arteries.
- Blood pressure aberrations are frequently observed post-TEA.
Purpose of the Study:
- To review the incidence, causes, and management of blood pressure abnormalities following carotid TEA.
- To assess the impact of these aberrations on perioperative stroke risk.
Main Methods:
- Retrospective review of 100 consecutive carotid TEA procedures.
- Analysis of patient records for blood pressure readings, reasons for surgery, and postoperative complications.
Main Results:
- 37% of patients experienced hypertension within 24 hours post-TEA, often due to pre-existing hypertension or carotid sinus changes.
- 6% experienced hypotension and bradycardia, likely from carotid sinus nerve hyperactivity.
- Nitroprusside was used for hypertension; atropine and epinephrine for hypotension.
Conclusions:
- Blood pressure aberrations are common after carotid TEA.
- Proper management strategies exist for both hypertension and hypotension.
- These blood pressure variations do not appear to be a significant risk factor for perioperative stroke when managed appropriately.
Abstract:
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.