Eversion technique increases the risk for post-carotid endarterectomy hypertension.
OBJECTIVE
The incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (e-CEA) was compared with that after standard carotid endarterectomy (s-CEA).


METHODS
In a retrospective analysis from January 1998 to January 2000, 217 patients underwent 219 CEAs for symptomatic (68) or asymptomatic (151) high-grade (>80%) carotid artery stenosis by either standard (137) or eversion (82) techniques. The eversion technique involves an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque. All procedures were done under general anesthesia, and somatosensory-evoked potentials were used for cerebral monitoring. Patients with s-CEA were compared with those with e-CEA for postoperative hemodynamic instability, carotid sinus nerve block, requirement for intravenous vasodilators or vasopressors, stroke, and death.


RESULTS
Patients who underwent e-CEA had a significantly (P <.005) increased postoperative blood pressure and required more frequent intravenous antihypertensive medication (24%), compared with patients having an s-CEA (6%). Furthermore, postoperative vasopressors were required after 10% of s-CEAs, but after none of the e-CEAs. No statistically significant difference was noted in the morbidity or mortality of patients after s-CEA and e-CEA.


CONCLUSIONS
e-CEA is a substantial risk factor for HTN in the immediate postoperative period, when compared with the s-CEA. This difference would be even more remarkable in the absence of antihypertensive medications in the e-CEA group and vasopressors in the s-CEA group. Therefore, particular attention should be focused on diagnosing and controlling postoperative HTN in patients after e-CEA.
Mehta
M
M
Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
Rahmani
O
O
Dietzek
A M
AM
Mecenas
J
J
Scher
L A
LA
Friedman
S G
SG
Safa
T
T
Ohki
T
T
Veith
F J
FJ
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery; D016022:Case-Control Studies; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
D000959:Antihypertensive Agents