Eversion technique increases the risk for post-carotid endarterectomy hypertension

Manish Mehta, Omid Rahmani, Alan M. Dietzek, John Mecenas, Larry A. Scher, Steven G. Friedman, Toufic Safa, Takao Ohki, Frank J. Veith

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

Objective: The incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (e-CEA) was compared with that after standard carotid endarterectomy (s-CEA). Methods: In a retrospective analysis from January 1998 to January 2000, 217 patients underwent 219 CEAs for symptomatic (68) or asymptomatic (151) high-grade (>80%) carotid artery stenosis by either standard (137) or eversion (82) techniques. The eversion technique involves an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque. All procedures were done under general anesthesia, and somatosensory-evoked potentials were used for cerebral monitoring. Patients with s-CEA were compared with those with e-CEA for postoperative hemodynamic instability, carotid sinus nerve block, requirement for intravenous vasodilators or vasopressors, stroke, and death. Results: Patients who underwent e-CEA had a significantly (P < .005) increased postoperative blood pressure and required more frequent intravenous antihypertensive medication (24%), compared with patients having an s-CEA (6%). Furthermore, postoperative vasopressors were required after 10% of s-CEAs, but after none of the e-CEAs. No statistically significant difference was noted in the morbidity or mortality of patients after s-CEA and e-CEA. Conclusion: e-CEA is a substantial risk factor for HTN in the immediate postoperative period, when compared with the s-CEA. This difference would be even more remarkable in the absence of antihypertensive medications in the e-CEA group and vasopressors in the s-CEA group. Therefore, particular attention should be focused on diagnosing and controlling postoperative HTN in patients after e-CEA.

Original languageEnglish (US)
Pages (from-to)839-845
Number of pages7
JournalJournal of Vascular Surgery
Volume34
Issue number5
DOIs
StatePublished - Nov 2001

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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