O250: Blood Pressure Homeostasis and Hyper-perfusion Syndrome Following Carotid Surgeries

Abstract

Abstract Objectives We aim to compare blood pressure homeostasis in patients undergoing bilateral versus unilateral carotid surgeries. Our primary endpoints are the incidence of postoperative hypertension and hyperperfusion syndrome (HPS). Secondary endpoints are major adverse cardiovascular events and all-cause mortality. Methods All patients undergoing carotid endarterectomy (CEA) from 2003 to 2022 were reviewed. We performed 1230 carotid interventions, of which 690 procedures had ten years of follow-up. Results Both the unilateral (512) and bilateral (91) carotid interventions caused a significant acute elevation in blood pressure (p<0.001). In unilateral carotid interventions, the mean SBP was 137 ± 19.90 mmHg preoperatively and 152 ± 25.80 postoperatively (p<0.001). Smoking (p=0.007), hyperfibrinogenemia (p=0.004), emergency admission (p=0.005), ipsilateral carotid stenosis >90% (p=0.022), and previous ipsilateral carotid intervention (p=0.003) were significantly associated with the development of postoperative hypertension. No incidence of HPS occurred in the unilateral group. In bilateral carotid interventions, the mean SBP was 138 ± 20.50 mmHg preoperatively and 159 ± 24.60 mmHg postoperatively (p<0.001). Emergency admission (p=0.012) and plaque morphology (p=0.035) were significantly associated with postoperative hypertension. Three patients with bilateral carotid interventions had HPS (3.3%) and developed hemorrhagic stroke within 30 days. Multivariate analysis found postoperative stage II hypertension following bilateral carotid procedures to be an independent predictor of stroke (p=0.004). However, postoperative hypertension was not an independent predictor of myocardial infarction (p=0.475) and mortality (p=0.608). Conclusion Significant acute elevation in blood pressure occurred following carotid surgeries. We observed HPS post bilateral carotid interventions, with postoperative hypertension being an independent predictor of peri-operative stroke.