Abstract PR047

Abstract

Background & Objectives: Intraoperative hemodynamic instability (IHI) is a well-known complication of carotid endarterectomy (CEA). It is a common perioperative finding depends on the timing and type of surgery, iatrogenic manipulation of the baroreceptors and is influenced by the anesthetic management. Carotid artery stenting (CAS) is an alternative to CEA and may be associated with hypotension and bradycardia due to predominantly parasympathetic activity during placement of the stent. This study aims to compare the incidence of IHI between CAS and CEA. Materials & Methods: The medical records of 80 patients underwent CAS and 101 patients underwent CEA under cervical plexus block during a 10 month period at our institution, were retrospectively reviewed. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) was used to classify CAS and CEA patients into 3 groups: low (I), medium (II) and high risk group (III), separately. IHI was defined as an increase/decrease in systolic and diastolic blood pressure or heart rate for ≥20% from basal value, for 2 minutes. In accordance to VSG-CRI, the incidence of IHI in low, medium and high risk group was compared among patients underwent CAS and CEA. Results: In line with VSG-CRI, patients underwent CEA were divided into three groups: group I consisted of 59 patients (56.2%), group II of 25 (23.8%) and group III of 21 (20%). Also, patients underwent CAS were divided into three groups, group I: 40 patients (50 %), group II: 30 (37.5%) and group III: 10 (12.5%). In low risk group, the incidence of bradycardia was significantly higher in the patients underwent CAS compared to the CEA patients (p=0.01). There was significantly higher incidence of IHI in the patients underwent CEA compared to the CAS patients in medium risk group (II) (p=0.03). In this group, diastolic blood pressure values immediately after cervical block application, were significantly higher in the patients underwent CEA compared to the CAS patients (p=0.009). Conclusion: According to VSG-CRI, in our study IHI and bradycardia were occured more often after CEA in medium and low risk group, respectively. This findings could suggest that the alteration of baroreceptor function is related more to the underlying carotid atherosclerotic disease that affects baroreceptor, than to the stenting procedure.