Hemodynamic Predictors And Changes During Carotid Endarterectomy Under Regional Anesthesia

Carotid endarterectomy (CEA) is the standard treatment for carotid stenosis, but it can lead to cerebral hypoperfusion and hemodynamic stroke. Regional anesthesia (RA) and light sedation allow continuous monitoring of intraoperative neurological function. However, the relationship between perioperative hemodynamic management and neurological dysfunction has yet to be thoroughly investigated. This study aims to identify hemodynamic patterns that are associated with intraoperative cerebral ischemia in CEA under RA.

Patients who underwent CEA at an academic tertiary referral center between January 2012 and December 2019 were included. Cases were individuals who developed intraoperative neurological deficits (ND). Consecutive controls without ND were sampled in 1:1 ratio.

154 patients were included, 78.6% male, and mean age was 70.1±9.1 years. Cases were on average older than controls (72.0 ± 9.90 vs 68.3 ± 8.3 years, p=0.012). Baseline systolic blood pressure (SBP) values were higher in the ND group (154.6 ± 31.8 vs 141.8 ± 41.2 mmHg, p=0.035), alongside pulse pressure (98.1 ± 24.0 vs. 87.4 ± 32 mmHg, p=0.023). The ND group also had a statistically significant higher mean arterial pressure at the 3rd-minute post-clamp (108.3 ± 19.7 vs 101.1 ± 20.2 mmHg, p=0.028) and a smaller drop in SBP between the pre-clamp and the 1st and 3rd minutes post-clamp (11.95±16.19 vs. 19.79±24.01 mmHg, p=0.021 and 11.12±21.83 vs 19.42±26.78 mmHg, p=0.039, respectively).

Intraoperative ND showed no characteristic predictive pattern, besides higher SBP. Hemodynamic management could be key for preventing unwanted deficits.