Eversion Carotid Endarterectomy is Associated with Decreased Baroreceptor Sensitivity Compared to the Conventional Technique

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• 作者：S. Demirel^a ; L. Macek^a ; H. Bruijnen^b ; M. Hakimi^a ; D. Bö ; ckler^a ; N. Attigah^a ; ^{nicolas.attigah@med.uni-heidelberg.de}
• 关键词：Carotid endarterectomy ; Eversion CEA ; Conventional CEA ; Baroreceptor sensitivity ; Carotid sinus nerve
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2012
• 期刊代码：122_10785884
• 类别：med
• 出版时间：July, 2012
• 卷：44
• 期：1
• 页码：1-8
• 文件大小：619 K

摘要

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聽=聽37) and C-CEA (n聽=聽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聽=聽0.01), diastolic pressure (DP) (P聽=聽0.008), MAP (P聽=聽0.002) and heart rate (HR) (P聽=聽0.03) on postoperative day 1 (POD-1). BRS decreased after E-CEA from 6.33 to 4.71聽ms聽mmHg^鈭? on POD-1 (P聽=聽0.001) and to 5.26聽ms聽mmHg^鈭? on POD-3 (P聽=聽0.0004). By contrast, BRS increased after C-CEA from 4.59 to 6.13聽ms聽mmHg^鈭? on POD-1 (P聽=聽0.002) and to 6.27聽ms聽mmHg^鈭? on POD-3 (P聽<聽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.