Perioperative blood pressure alterations after eversion and conventional carotid endarterectomy sustain in the midterm.
OBJECTIVE
Carotid endarterectomy (CEA) is associated with a profound effect on blood pressure. The aim of this study was to evaluate 24 h ambulatory blood pressure measurement (ABPM) after eversion (E-CEA) and conventional (C-CEA) endarterectomy including a midterm follow-up.


METHODS
Seventy-one patients were included in this prospective study [E-CEA (37)/C-CEA (34)]. Daytime (8 a.m. to 10 p.m.) and nighttime (10 p.m. to 8 a.m.) ABPMs were analyzed perioperatively and at midterm after a median follow-up period of 9.5 months (interquartile range (IQR) 6.4-17.8) in the E-CEA group and 11.5 months (IQR 8.3-13.6) in the C-CEA group


RESULTS
Patient 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 three. 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 (P < 0.001 daytime, P < 0.01 nighttime) and again on day 3 (P < 0.001 daytime, P < 0.01 nighttime). 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). Midterm results showed no difference of average blood pressure values, but an increased maximal blood pressure (P = 0.01 daytime) and heart rate (HR) (P = 0.006 daytime) were reached in the E-CEA group and decreased HR (P = 0.01 nighttime) in the C-CEA group. Compared with baseline [(E-CEA: median (IQR) 2 (1-3); C-CEA: median (IQR) 2 (1-3)], the number of antihypertensive medications at midterm was significantly higher in the E-CEA group [(median (IQR) 3 (2-3) vs. 2 (2-3), P = 0.002)]. In both groups, no adverse cardiovascular or cerebrovascular events during follow-up could be observed.


CONCLUSIONS
Although the initial hypertensive effect of E-CEA diminishes during midterm follow-up, patients undergoing eversion endarterectomy keep needing more antihypertensive medications and are prone to develop higher maximal blood pressure.
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
Benedikta
B
Burgmer
Dittmar
D
Böckler
D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D016894:Endarterectomy, Carotid; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric