Changes in baroreceptor sensitivity after eversion carotid endarterectomy

Abstract

E-CEA might have a decreasing influence on BRS, leading to increased sympathetic activity. Investigations of the longer-term effects of impaired BRS are warranted. These findings should be interpreted with caution, noting the limitation of an absent control group.

Altered blood pressure responses of carotid endarterectomy in patients with contralateral carotid artery lesion

“…[6,11,12] Several studies have demonstrated that hypertension caused by baroreflex dysfunction is associated with higher levels of cardiovascular and neurological mortality and morbidity. [1][2][3]13] Untreated hypertension is often considered to be one of the independent risk factors for poor outcome following CEA. While certain studies describe a positive relation between perioperative hypertension and the risk of poor neurological outcome or death after CEA, other studies have not found such a relationship.…”

“…[1,3,16,17] A several variety of causes described in numerous studies as factors which significantly contribute to the development of hypertension include the severity and side of carotid stenosis; prior ipsilateral hemispheric neurological symptoms (stroke or TIA); the presence of contralateral disease; history of previous ipsilateral or contralateral carotid surgery; and the surgical techniques being used. [6,16,[18][19][20][21] Furthermore, several studies have defined preoperative neurological deficits as independent predictors of hypertension following CEA.…”

“…[1,3,16,24,25] Eversion CEA is associated with a higher incidence of postoperative hypertension, higher levels of vasodilator use, and lower levels of vasopressor use after surgery compared to standard longitudinal endarterectomy with or without patch angioplasty. [1,3] This finding is most likely to be attributed to the baroreceptor apparatus and the almost certain need for carotid sinus nerve transection using the eversion technique. [3] On the other hand, increased carotid bulb diameters in patch angioplasty, following C-CEA, may cause an increased wall tension, which is at the same ratio as that of the intraluminal arterial pressure.…”

“…[1,2] Baroreceptors are one of the main components of the physiological blood pressure control mechanism, which play an active role in the autoregulation of the blood flow. [1] Therefore, carotid surgical procedures have the potential to affect the baroreceptors.…”

“…[1,2] Baroreceptors are one of the main components of the physiological blood pressure control mechanism, which play an active role in the autoregulation of the blood flow. [1] Therefore, carotid surgical procedures have the potential to affect the baroreceptors. [2] The well-defined conventional and eversion carotid endarterectomy (C-CEA, E-CEA) techniques used in the carotid artery stenosis treatment often reduce the physiological baroreflex reserve, and, therefore, disrupt the blood pressure homeostasis.…”