title: Comparison of catecholamine hormone release in patients undergoing carotid artery stenting or carotid endarterectomy.
abstract: OBJECTIVE
  To investigate the pattern of catecholamine response in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS).
  
  
  METHODS
  Adrenaline, noradrenaline, and renin levels were measured at 5 time points in 12 patients undergoing 13 CEAs (1 bilateral) and 13 patients undergoing unilateral CAS. Arterial blood samples were taken at the following time points: (1) after induction in CEA patients or 5 minutes following first contrast injection in CAS patients, (2) 5 minutes following ICA clamp release in surgical patients or deflation of the balloon in the CAS cohort, (3) 60 minutes following ICA clamp release in surgical patients or deflation of the balloon in the CAS cohort, and (4) 24 hours following the procedure. Intraoperative blood pressure and heart rate were recorded using radial arterial monitoring. Changes in adrenaline, noradrenaline, and renin levels are expressed as ratios versus baseline.
  
  
  RESULTS
  Patterns of adrenaline and noradrenaline release were significantly different in patients undergoing CAS and CEA, with much higher and more variable surges of adrenaline and noradrenaline occurring in CEA patients. Adrenaline and noradrenaline levels increased significantly over baseline following carotid artery clamping in patients undergoing CEA (noradrenaline ratio before clamping: 1.54+/-1.25, 24 hours after unclamping: 8.38+/-16.35 [p<0.001]; adrenaline ratio before clamping: 1.12+/-0.49, 60 minutes after unclamping: 17.59+/-19.14 [p<0.001]). Conversely, in patients undergoing CAS, catecholamine levels remained unchanged (noradrenaline ratio before dilation: 0.96+/-0.23, 24 hours after the procedure: 0.92+/-0.32 [p=NS]; adrenaline ratio before dilation: 0.83+/-0.33, 60 minutes after balloon deflation: 0.56+/-0.32 [p=NS]).
  
  
  CONCLUSIONS
  CAS is associated with a significantly less marked catecholamine response than CEA, which may reflect down-regulation of the sympathetic nervous system in response to carotid sinus stimulation during carotid angioplasty.
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. maryclairebarry@eircom.net
authors.forename: Mary Claire
authors.initials: MC
authors.lastname: Barry
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Hendriks
authors.forename: Gooitzen
authors.initials: G
authors.lastname: Alberts
authors.forename: Frans
authors.initials: F
authors.lastname: Boomsma
authors.forename: Lukas C
authors.initials: LC
authors.lastname: Van Dijk
authors.forename: Peter M T
authors.initials: PM
authors.lastname: Pattynama
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
authors.forename: David J
authors.initials: DJ
authors.lastname: Bouchier-Hayes
authors.forename: Hero
authors.initials: H
authors.lastname: Van Urk
authors.forename: Marc R H M
authors.initials: MR
authors.lastname: Van Sambeek
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000097:blood / Q000628:therapy*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D004837:Epinephrine / Q000097:blood*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D011446:Prospective Studies; D012083:Renin / Q000097:blood*; D015607:Stents
chemical_list: D012083:Renin; D009638:Norepinephrine; D004837:Epinephrine