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Hemodynamic instability after carotid endarterectomy: risk factors and associations with operative complications
J H Wong1, J M Findlay, M E Suarez-Almazor
1Division of Neurosurgery, MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Canada.
Insights
Postoperative hypertension after carotid endarterectomy (CEA) is linked to stroke or death. Patients require monitoring in specialized settings for prompt management of neurological and cardiovascular emergencies.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
- Postoperative hemodynamic instability is a concern after CEA.
- Identifying predictors of adverse outcomes is crucial for patient management.
Purpose of the Study:
- To determine the incidence of hypertension, hypotension, and bradycardia following CEA.
- To identify hemodynamic variables that predict postoperative stroke, death, or cardiac complications.
Main Methods:
- Retrospective cohort study of 291 patients undergoing CEA.
- Hemodynamic data collected from recovery room to the first postoperative day.
- Outcomes included 30-day stroke/death and postoperative cardiac complications.
Main Results:
- Incidences: hypertension 9%, hypotension 12%, bradycardia 55%.
- Stroke or death rate was 5.2%.
- Postoperative hypertension significantly correlated with stroke/death (P=0.04) and trended with cardiac complications (P=0.07).
Conclusions:
- Hemodynamic instability is common post-CEA, with hypertension being the key predictor of adverse events.
- Preoperative factors like intracranial stenosis and renal insufficiency predict postoperative hypertension.
- Patients need monitoring in settings equipped for rapid neurological and cardiovascular emergency management.
Objective:
To examine the incidences of hypertension, hypotension, and bradycardia after carotid endarterectomy (CEA) and to identify any hemodynamic variables predictive of postoperative stroke, death, or cardiac complications.
Methods:
Retrospective population-based cohort study of 291 consecutive patients undergoing CEA using hospital chart review. Hemodynamic data collected from time of arrival in the recovery room until the end of the 1st postoperative day. Primary and secondary outcome events were stroke or death within 30 days of surgery and any postoperative cardiac complication (angina, congestive heart failure, dysrhythmia, or myocardial infarction), respectively.
Results:
The incidences of postoperative hypertension (systolic blood pressure > 220 mm Hg), hypotension (systolic blood pressure < 90 mm Hg), and bradycardia (pulse < 60 beats/min) were 9% (26 of 290 cases), 12% (36 of 290 cases), and 55% (159 of 290 cases), respectively. The stroke or death rate was 5.2% (15 of 291 cases). Postoperative hypertension was associated significantly with stroke or death (P = 0.04) and by a statistical trend with cardiac complications (P = 0.07). Independent preoperative risk factors for postoperative hypertension by multivariate analysis included angiographic intracranial carotid stenosis greater than 50%, cardiac dysrhythmia, preoperative systolic blood pressure greater than 160 mm Hg, neurological instability, and renal insufficiency. Postoperative hypotension and bradycardia did not correlate with primary or secondary outcomes.
Conclusion:
Hemodynamic instability was commonly observed after CEA, but only postoperative hypertension was associated with stroke or death and, possibly, with cardiac complications. Patients undergoing CEA, especially those at risk for postoperative hypertension, may be monitored best in settings suited to the expeditious management of neurological and cardiovascular emergencies.