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Abstract

We would like to thank Dr Ballotta and associates for their interest in our work regarding the increased risk of postoperative hypertension following eversion carotid endarterectomy. Although prospective randomized trials have analyzed the incidence of postoperative recurrent stenosis, occlusion, stroke, and death following either eversion or standard carotid endarterectomy techniques, the difference in the incidence and severity of postoperative hypertension following carotid endarterectomy by the two techniques had not been compared prior to our evaluation of this subject matter. Dr Ballotta and associates have published two excellent articles on prospective evaluation of techniques of carotid endarterectomy, eversion versus standard patch closure.1,2 On evaluating 86 patients with sequential, bilateral carotid endarterectomies via eversion and standard techniques, they have come to a conclusion that is quite different than what is supported by our data. They have not noticed a statistically significant difference in the incidence of post-carotid endarterectomy hypertension among patients undergoing endarterectomy via eversion (13%) and standard (6%) techniques (P =.18). The lack of statistical power of their data could simply be the result of a type II error. It is unfortunate that Dr Ballotta's data did not reach statistical significance, considering that it actually supports our data in that eversion carotid endarterectomy is associated with an increased risk for post-carotid endarterectomy hypertension. Even in their patient cohort, postoperative hypertension developed more frequently following eversion technique (13%) than standard technique (6%). Furthermore, 3.5% of their patients experienced postoperative hypotension after standard carotid endarterectomy, and none did so after eversion carotid endarterectomy. We would once again like to thank Dr Ballotta and his colleagues for their comments.