Hemodynamic changes in different types of carotid endarterectomy in the short- and long-term postoperative periods in patients with carotid artery stenosis

Aim. To compare a novel technique of carotid endarterectomy (CEA) with autoarterial remodeling (AAR) of carotid bifurcation and the conventional patch angioplasty in relation to effect on 24-hour blood pressure (BP) and heart rate (HR) in the short- and long-term postoperative periods.

Material and methods. This prospective, randomized, comparative trial included 200 patients which were divided into 2 groups: group 1 (n=100) — patients after CEA with AAR, group 2 (n=100) — patients after conventional xeno-pericardial patch repair. Twenty four-hour monitoring of BP and HR was performed before and after surgical treatment, both in short- and long-term postoperative periods in both groups. The follow-up period was 3 years.

Results. Surgery in both groups was associated with an increase in HR, systolic and diastolic hypertension time index. Damage to carotid sinus enhances sympathetic innervation and disrupts the baroreflex regulation. Conclusion. The study did not reveal a significant difference in the incidence of postoperative hypertension and the dependence of HR on sel ected surgical technique. Thus, the proposed novel method of CEA with AAR of carotid bifurcation does not increase the risk of preexisting hypertension.

1. Chernyavskiy АМ, Vinogradova ТЕ. The long-term experience of the ischemic stroke surgical prevention. Patologiya krovoobrascheniya i kardiohirurgiya. 2012;4:21-6. (In Russ.) doi:10.21688/1681-3472-2012-4-21-26.

2. Orrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2017;6(6):CD001081. doi:10.1002/14651858.CD001081.pub3.

3. Dangas G, Laird JR, Satler LF, et al. Postprocedural hypotension after carotid artery stent placement: predictors and short- and long-term clinical outcomes. Radiology. 2000;215(3):677-83. doi:10.1148/radiology.215.3.r00jn04677.

4. Kamenskiy AV, Pipinos II, Dzenis YA, et al. A mathematical evaluation of hemodynamic parameters after carotid eversion and conventional patch angioplasty. Am J Physiol Heart Circ Physiol. 2013;305:716-24. doi:10.1152/ajpheart.00034.2013.

5. Ben Ahmed S, Daniel G, Benezit M, et al. Does the technique of carotid endarterectomy determine postoperative hypertension? Ann Vasc Surg. 2015;29:1272-80. doi:10.1016/j.avsg.2015.03.033.

6. Mehta M, Rahmani O, Dietzek AM, et al. Eversion technique increases the risk for post-carotid endarterectomy hypertension. J Vasc Surg. 2001;34:839-45. doi:10.1067/mva.2001.118817.

7. Bove EL, Fry WJ, Gross WS, et al. Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy. Surgery. 1979;85:633-7 doi:10.1007/s00104-017-0502-4.

8. Ahn SS, Marcus DR, Moore WS. Post-carotid endarterectomy hypertension: association with elevated cranial norepinephrine. J Vasc Surg. 1989;9:351-60. doi:10.1016/0741-5214(89)90056-6.

9. Smith BL. Hypertension following carotid endarterectomy: the role of cerebral renin production. J Vasc Surg. 1984;1:623-7 doi:10.1016/0741-5214(84)90126-5.

10. Michalinos A, Chatzimarkos M, Arkadopoulos N, et al. Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation. Anat Res Int. 2016;2016:6907472. doi:10.1155/2016/6907472.

11. Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res. 2014; 114(11):1804-14. doi: 10.1161/CIRCRESAHA.114.302524.

12. Tang TY, Walsh SR, Gillard JH, et al. Carotid sinus nerve blockade to reduce blood pressure instability following carotid endarterectomy: a systematic review and meta-analysis. European Journal of Vascular and Endovascular Surgery. 2007;34(3):304-11. doi:10.1016/j.ejvs.2007.02.024.

13. Cao Q, Zhang J, Xu G. Hemodynamic changes and baroreflex sensitivity associated with carotid endarterectomy and carotid artery stenting. Interv Neurol. 2015;3( 1): 13-21. doi:10.1159/000366231.

14. Al-Rawi PG, Sigaudo-Roussel D, Gaunt ME. Effect of lignocaine injection in carotid sinus on baroreceptor sensitivity during carotid endarterectomy. J Vasc Surg. 2004;39:1288-94. doi: 10.1016/j.jvs.2004.02.005.

15. Fearn SJ, Mortimer AJ, Faragher EB, et al. Carotid sinus nerve blockade during carotid surgery: a randomized controlled trial. Eur J Vasc Endovasc Surg. 2002;24(6):480-4. doi: 10.1053/ejvs.2002.1779.

16. Gottlieb A, Satariano-Hayden P, Schoenwald P, et al. The effects of carotid sinus nerve blockade on hemodynamic stability after carotid endarterectomy. J Cardiothorac Vasc Anesth. 1997; 11:6771. doi:10.1016/S1053-0770(97)90256-1.

17. 17 Tang TY, Howarth SP, Miller SR, et al. The ATHEROMA (Atorvastatin Therapy: Effects on Reduction of Macrophage Activity) Study: evaluation using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging in carotid disease. J Am Coll Cardiol. 2009;53(22):2039-50. doi:10.1016/j.jacc.2009.03.018.

18. Demirel S, Goossen K, Bruijnen H, et al. Systematic review and meta-analysis of postcarotid endarterectomy hypertension after eversion versus conventional carotid endarterectomy. J Vasc Surg. 2017;65(3):868-82. doi:10.1016/j.jvs.2016.10.087.