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Eversion carotid endarterectomy is associated with decreased baroreceptor sensitivity compared to the conventional technique

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 conventiona...

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Main Authors: Demirel, Serdar (Author) , Macek, Laura (Author) , Hakimi, Maani (Author) , Böckler, Dittmar (Author) , Attigah, Nicolas (Author)
Format: Article (Journal)
Language:English
Published: 8 May 2012
In: European journal of vascular and endovascular surgery
Year: 2012, Volume: 44, Issue: 1, Pages: 1-8
ISSN:1532-2165
DOI:10.1016/j.ejvs.2012.04.009
Online Access:Verlag, Volltext: http://dx.doi.org/10.1016/j.ejvs.2012.04.009
Verlag, Volltext: https://linkinghub.elsevier.com/retrieve/pii/S1078588412002493
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Author Notes:S. Demirel, L. Macek, H. Bruijnen, M. Hakimi, D. Böckler, N. Attigah
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Summary: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 ¼ 37) and C-CEA (n ¼ 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 ¼ 0.01), diastolic pressure (DP) (P ¼ 0.008), MAP (P ¼ 0.002) and heart rate (HR) (P ¼ 0.03) on postoperative day 1 (POD-1). BRS decreased after E-CEA from 6.33 to 4.71 ms mmHgÀ1 on POD-1 (P ¼ 0.001) and to 5.26 ms mmHgÀ1 on POD-3 (P ¼ 0.0004). By contrast, BRS increased after CCEA from 4.59 to 6.13 ms mmHgÀ1 on POD-1 (P ¼ 0.002) and to 6.27 ms mmHgÀ1 on POD-3 (P < 0.0001). Conclusion: 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.
Item Description:Gesehen am 26.02.2019
Physical Description:Online Resource
ISSN:1532-2165
DOI:10.1016/j.ejvs.2012.04.009

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