Assessing the Impact of the Sinus-Saving Modifications of Carotid Endarterectomy in the Autonomic Regulation and Central Hemodynamics

Abstract

Introduction: There are many dangerous complications, such as myocardial infarction, hyperperfusion syndrome and its effects, hematomas in the postoperative period after carotid surgery. One of the main causes of these complications is the variation of central hemodynamic especially with the tendency to hypertension. Our goal is to develop an operative technique that could let us avoid the intersection of the carotid sinus nerves, which reduce the risk of complications thanks to a more manageable blood pressure, due to decreased sympathetic influence on the regulation of vascular tone. Methods: During our retrospective analysis 384 cases had been investigated. Prior to inclusion in the study, written informed consent was obtained from all participants. Patients were separated into two groups. Groups are even in age, sex, initial neurological and cardiac status and contralateral blood flow. The first group of patients (203 patients) had cut the carotid sinus nerves. Carotid sinus nerves of patients from the second group (181 patients) were kept safe. Evaluated the following parameters – systolic blood pressure, diastolic blood pressure, heart rate and pulse pressure. We are interested in the period – 1st and 4th days after surgery when the risk of complications and changes in hemodynamics is particularly high. Also on the 1st and 4th day after surgery, the state of the autonomic regulation was assessed by analyzing heart rate variability. We prospectively analyzed the autonomic regulation of 16 patients from the first group and 19 patients from the other one, observing a variety of heart rate at neurocardiological laboratory. Results: On the second postoperative day all the hemodynamic indicators (as SBP, DBP, pulse pressure, heart rate) had much lower levels in the second group of patients (p<0,05) with the recovery of normal numbers on the third day. This fact kept postoperative complications to a minimum. In the group of patients with saved carotid sinus nerve on the 1st day after surgery was more than a noticeable decrease sympathetic influence on the rhythm, with a tendency to restore autonomic regulation on the 4th day. These results explain the difference between central hemodynamic indicators in two groups. Conclusion: Obtained results show the lower activity of the sympathetic and the high activity of the parasympathetic system in the group with non-damaged carotid sinus nerves. The practical application of the sine-saving modification of eversion carotid endarterectomy allows reducing the risk of postoperative complications caused by arterial hypertension.