title: Eversion carotid endarterectomy is associated with decreased baroreceptor sensitivity compared to the conventional technique.
abstract: OBJECTIVE
  Impairment of baroreceptor sensitivity (BRS) has been shown to be associated with blood pressure instability after carotid endarterectomy (CEA). The aim of this study was to determine whether there is a difference in postoperative BRS changes following eversion CEA (E-CEA) and conventional CEA (C-CEA).
  
  
  METHODS
  Sixty-four patients undergoing E-CEA (n = 37) and C-CEA (n = 27) were prospectively studied. Non-invasive measurements of mean arterial pressure (MAP), cardiac output (CO) and total peripheral resistance (TPR) were perioperatively obtained over three 10-min periods. Baroreflex gain was calculated as the sequential cross-correlation between heart rate and beat-to-beat systolic blood pressure.
  
  
  RESULTS
  Compared with changes observed after C-CEA, E-CEA was associated with an increase in systolic pressure (SP) (P = 0.01), diastolic pressure (DP) (P = 0.008), MAP (P = 0.002) and heart rate (HR) (P = 0.03) on postoperative day 1 (POD-1). BRS decreased after E-CEA from 6.33 to 4.71 ms mmHg(-1) on POD-1 (P = 0.001) and to 5.26 ms mmHg(-1) on POD-3 (P = 0.0004). By contrast, BRS increased after C-CEA from 4.59 to 6.13 ms mmHg(-1) on POD-1 (P = 0.002) and to 6.27 ms mmHg(-1) on POD-3 (P < 0.0001).
  
  
  CONCLUSIONS
  E-CEA and C-CEA have different effects on BRS. This is associated with an altered haemodynamic behaviour after E-CEA and C-CEA, respectively. These findings are likely the result of carotid sinus nerve interruption during E-CEA and preservation with C-CEA.
authors.affiliation: Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Demirel
authors.forename: L
authors.initials: L
authors.lastname: Macek
authors.forename: H
authors.initials: H
authors.lastname: Bruijnen
authors.forename: M
authors.initials: M
authors.lastname: Hakimi
authors.forename: D
authors.initials: D
authors.lastname: Böckler
authors.forename: N
authors.initials: N
authors.lastname: Attigah
mesh_terms: D000368:Aged; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D002339:Carotid Arteries / Q000294:innervation / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications; D011184:Postoperative Period; D011311:Pressoreceptors / Q000503:physiopathology*; D011446:Prospective Studies; D014655:Vascular Resistance / Q000502:physiology