Hemodynamic Predictors And Changes During Carotid Endarterectomy Under Regional Anesthesia

Area of Science:

• Neurosurgery
• Anesthesiology
• Vascular Surgery

Background:

• Carotid endarterectomy (CEA) is a standard procedure for carotid stenosis.
• Cerebral hypoperfusion and stroke are potential complications of CEA.
• Regional anesthesia (RA) with light sedation allows intraoperative neurological monitoring.

Purpose of the Study:

• To identify hemodynamic patterns associated with intraoperative cerebral ischemia during CEA under RA.
• To investigate the relationship between perioperative hemodynamic management and neurological dysfunction.

Main Methods:

• Retrospective analysis of patients undergoing CEA between 2012 and 2019.
• Inclusion of cases with intraoperative neurological deficits (ND) and matched controls without ND.
• Comparison of demographic and hemodynamic parameters between cases and controls.

Main Results:

• 154 patients included; cases with ND were older and had higher baseline systolic blood pressure and pulse pressure.
• The ND group exhibited higher mean arterial pressure post-clamp and a smaller drop in systolic blood pressure.
• No distinct predictive hemodynamic pattern for intraoperative ND was identified beyond elevated systolic blood pressure.

Conclusions:

• Intraoperative neurological deficits in CEA under RA did not show a clear predictive hemodynamic pattern, apart from higher systolic blood pressure.
• Optimized perioperative hemodynamic management may be essential for preventing neurological complications during CEA.