Perioperative blood pressure alterations after eversion and conventional carotid endarterectomy sustain in the midterm

Abstract

Carotid endarterectomy (CEA) is associated with a profound effect on blood pressure. The aim of this study was to evaluate 24h ambulatory blood pressure measurement (ABPM) after eversion (E-CEA) and conventional (C-CEA) endarterectomy including a midterm follow-up. Seventy-one patients were included in this prospective study [E-CEA (37)/C-CEA (34)]. Daytime (8a.m. to 10p.m.) and nighttime (10p.m. to 8a.m.) ABPMs were analyzed perioperatively and at midterm after a median follow-up period of 9.5months (interquartile range (IQR) 6.4-17.8) in the E-CEA group and 11.5months (IQR 8.3-13.6) in the C-CEA group Patient demographics and preoperative antihypertensive regimens were similar in the two groups. Compared with baseline, ABPM decreased on postoperative day 1 in the C-CEA group (P < 0.01) but normalized by day three. By contrast, ABPM values were unchanged on day 1 in the E-CEA group but increased above baseline on day 3 (P < 0.01). E-CEA was associated with higher ABPM on day 1 (P < 0.001 daytime, P < 0.01 nighttime) and again on day 3 (P < 0.001 daytime, P < 0.01 nighttime). The use of vasodilators was more frequent in the E-CEA group, both in the recovery room (P = 0.007) and on the ward (P = 0.004). Midterm results showed no difference of average blood pressure values, but an increased maximal blood pressure (P = 0.01 daytime) and heart rate (HR) (P = 0.006 daytime) were reached in the E-CEA group and decreased HR (P = 0.01 nighttime) in the C-CEA group. Compared with baseline [(E-CEA: median (IQR) 2 (1-3); C-CEA: median (IQR) 2 (1-3)], the number of antihypertensive medications at midterm was significantly higher in the E-CEA group [(median (IQR) 3 (2-3) vs. 2 (2-3), P = 0.002)]. In both groups, no adverse cardiovascular or cerebrovascular events during follow-up could be observed. Although the initial hypertensive effect of E-CEA diminishes during midterm follow-up, patients undergoing eversion endarterectomy keep needing more antihypertensive medications and are prone to develop higher maximal blood pressure.