Eversion carotid endarterectomy is associated with impaired postoperative hemodynamic stability compared with the conventional technique.
BACKGROUND
Carotid endarterectomy is associated with a profound effect on blood pressure. The aim of this study was to evaluate 24-hour ambulatory blood pressure measurements (ABPMs) after eversion carotid endarterectomy (E-CEA) and conventional carotid endarterectomy (C-CEA).


METHODS
Seventy-one patients were included in this prospective study (E-CEA [37]/C-CEA [34]). Daytime (8 AM-10 PM) and nighttime (10 PM-8 AM) ABPMs were analyzed preoperatively and on postoperative days 1 and 3.


RESULTS
Patients' demographics and preoperative antihypertensive regimens were similar in the two groups. Compared with baseline, ABPM decreased on postoperative day 1 in the C-CEA group (P < 0.01) but normalized by day 3. By contrast, ABPM values were unchanged on day 1 in the E-CEA group but increased above baseline on day 3 (P < 0.01). E-CEA was associated with higher ABPM on day 1 (daytime: P < 0.001; nighttime: P < 0.01) and again on day 3 (daytime: P < 0.001; nighttime: P < 0.01). The use of vasodilators was more frequent in the E-CEA group, both in the recovery room (P = 0.007) and on the ward (P = 0.004).


CONCLUSIONS
E-CEA may be associated with higher postoperative blood pressure and the need for more additional antihypertensive therapy in the postoperative period compared with C-CEA.
Department of Vascular and Endovascular Surgery, University Hospital of Ruprecht-Karls, Heidelberg, Germany. serdar.demirel@med.uni-heidelberg.de
Serdar
S
Demirel
Nicolas
N
Attigah
Hans
H
Bruijnen
Maani
M
Hakimi
Laura
L
Macek
Dittmar
D
Böckler
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005858:Germany; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D014665:Vasodilator Agents