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Hemodynamic Predictors And Changes During Carotid Endarterectomy Under Regional Anesthesia.

Vera A Silva1, Luís D Gamas2, Juliana Pereira-Macedo3

  • 1Faculty of Medicine, University of Porto, Portugal.

Portuguese Journal of Cardiac Thoracic and Vascular Surgery
|May 6, 2025
PubMed
Summary
This summary is machine-generated.

This study investigated hemodynamic patterns during carotid endarterectomy (CEA) under regional anesthesia. Results indicate higher baseline systolic blood pressure may be linked to neurological deficits, suggesting hemodynamic management is crucial for preventing complications.

Keywords:
awake testcarotid stenosishemodynamic monitoringlocoregional anesthesianeurologic exam

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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.