Eversion Carotid Endarterectomy is Associated with Decreased Baroreceptor Sensitivity Compared to the Conventional Technique

Abstract

E-CEA and C-CEA have different effects on BRS. This is associated with an altered haemodynamic behaviour after E-CEA and C-CEA, respectively. These findings are likely the result of carotid sinus nerve interruption during E-CEA and preservation with C-CEA.

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

“…[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. [3] In this study, the presence of these important variables was excluded as a possible risk factor for postoperative hypertension, while the presence of lesions of the contralateral carotid artery was identified as a significant risk factor for postoperative hypertension.…”

“…[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.…”

“…[1,3,16,17] 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.…”

“…[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.…”

“…[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. [3][4][5][6] In addition, the presence of contralateral carotid artery stenosis is also one of the important variables which affects the blood pressure homeostasis during carotid artery surgery. [2] In this study, we evaluated altered blood pressure responses within the first three days following carotid endarterectomy in patients with contralateral carotid artery lesion.…”