Hemodynamic Changes in Chevalier Eversion Versus Conventional Carotid Endarterectomy

Taurino, Maurizio; Filippi, Federico; Persiani, Francesca; Tirotti, C.; Dito, Raffaele; Brancadoro, D; Rizzo, Luigi

doi:10.1016/j.ejvs.2014.08.005

Cited by 13 publications

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

Akyüz¹

2016

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada kontralateral karotis arter lezyonu olan hastalarda karotis endarterektomiyi takiben ilk üç gün içinde değişmiş kan basıncı yanıtları değerlendirildi.Ça lış ma pla nı: Mart 2009 -Kasım 2012 tarihleri arasında karotis endarterektomi yapılan toplam 111 hasta (52 erkek, 59 kadın; ort. yaş 67.7±8.6 yıl; dağılım 46-83 yıl) retrospektif olarak incelendi. Hastalar iki gruba ayrıldı: kontralateral karotis arter patent olan (grup 1, n=65) ve kontralateral karotis arter darlığı (%50-99) veya tıkanıklığı olan (grup 2, n=44). Ameliyat sonrası izlem sırasında başlangıca kıyasla kan basıncındaki değişiklikler incelendi ve gruplar arasında karşılaştırıldı. Bul gu lar:Ameliyat sonrası dönemde, grup 1'e kıyasla, grup 2 hastalarında sistolik, diyastolik ve ortalama arteriyel basınç değerleri istatistiksel olarak daha yüksekti (p<0.05). Ameliyat sonrası dönemde intravenöz antihipertansif ilaç ihtiyacı, grup 1'e kıyasla, grup 2'de anlamlı düzeyde daha fazla idi (p<0.05). Karotis endarterektomi sonrası yatış sırasında grup 2'de 25 hastada (%56.8) ve grup 1'de 14 hastada (%21.5) mevcut antihipertansif tedavinin dozu artırıldı veya antihipertansif tedaviye ilaç eklendi (p<0.05). Grup 2'de bir hastada geçici iskemi atak şeklinde nörolojik komplikasyon görüldü. İki grupta da hiçbir hastada ameliyat sonrası anlamlı nörolojik, cerrahi veya kardiyak komplikasyon gelişmedi.So nuç: Bu çalışma, karotis endarterektomi planlanan hastaların kontralateral internal karotis arterde darlık (%50-99) veya tıkanma varlığında ameliyat sonrası hipertansiyon açısından yüksek riskli olduğunu gösterdi.Anah tar söz cük ler: Karotis endarterektomi; kontralateral darlık; tıkanma; ameliyat sonrası hipertansiyon. ABSTRACT Background:In this study, we evaluated altered blood pressure responses within the first three days following carotid endarterectomy in patients with contralateral carotid artery lesion.

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Section: Discussionmentioning

confidence: 99%

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

Akyüz¹

2016

Turk Gogus Kalp Dama

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“…Клиника повреждения блуждающего нерва разнообразна: при повреждении возвратного гортанного нерва формируется парез голосовой связки, проявляющийся афонией и охриплостью голоса [8].…”

Section: Cite This Article Asunclassified

“…при повреждении же основного ствола могут наблюдаться вышеописанные симптомы, также дисфагия, синусовая тахикардия, гиперсаливация, свисание мягкого неба на стороне поражения, отсутствие небного и глоточного рефлекса, отклонение язычка в здоровую сторону [8].…”

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Analysis and methods of prevention of cranial nerves injury during carotid endarterectomy

Matyushkin

Мустафин

2019

Innovacionnaâ medicina Kubani

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Aim. CEAE is an effective method of ischemic stroke prevention. However, as any invasive treatment method, CEAE is associated with a risk of complications in the early and late postoperative periods. One of the possible complications is intraoperative injury of cranial nerves.Material and methods. From 2008 to 2014 in the department of vascular surgery in Pletnev City Hospital in Moscow, 172 patients with hemodynamically significant ICA stenosis who suffered ischemic stroke or TIA underwent surgery.Results. In the early postoperative period, 7 episodes of cranial nerve injury (4.0%) were detected. The following cranial nerves were most often damaged during surgery: the terminal branches of the facial nerve (VII), the hypoglossus nerve (XII), the glossopharyngeal nerve (IX), and the vagus nerve (X). Injuries were associated with coagulation damage or compression of nerves. In one case, the intersection of the hypoglossus nerve was recorded. In all cases except this one, nerve damage was reversible.Conclusion. It is impossible to avoid cranial nerves injury during carotid endarterectomy. However, the number of such complications can be reduced by the measures described in this article.

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“…The study by Marrocco-Trischitta et al does not specify whether techniques to preserve the sinus nerve, such as the technique described by Taurino et al, 6 were used during dissection of the carotid bulb. 6 Whether carotid sinus nerve function is preserved after e-CEA is a question of surgical finesse and is subject to diverse ongoing clinical trials.…”

Section: Replymentioning

confidence: 99%

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Demirel

2015

Journal of Vascular Surgery

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from carotid baroreceptors and chemoreceptors ascend in anatomic proximity in the carotid sinus nerve, and therefore, the sequelae of baroreceptor and chemoreceptor denervation as a result of an iatrogenic injury typically arise in parallel.If the theory of Demirel et al were correct, patients who undergo bilateral e-CEA would represent a human model of carotid sinus denervation. In fact, we proved in our previous study 2 that this is not the case. Also, in patients treated with bilateral CEA not only were both baroreflexes and chemoreflexes preserved regardless the surgical technique, but unexpectedly, baroreflexes appeared better maintained in e-CEA than in patch CEA. Finally, we found that e-CEA, even when performed on both sides, did not increase long-term arterial pressure variability, and this suggests that perioperative hemodynamic derangements can be attributed to the temporary effects of surgical trauma.Finally, the remarks about our methods by Demirel et al 1 appear incorrect and inaccurate. In humans, the lack of carotid baroreceptors is not completely compensated by aortic and cardiopulmonary baroreceptors. 4 Furthermore, we did not perform only standard cardiovascular reflex tests but also spectral analysis of heart rate and blood pressure variability and concurrent peripheral chemoreflex function analysis that specifically accounts for the integrity of the carotid sinus nerve. Rather, the authors claim that in their study "unilateral carotid baroreflex function could be assessed in an invasive way, allowing a full pressure transmission to the carotid baroreceptors located in the carotid bulb." In fact, they more prosaically retrospectively reviewed patient records and compared perioperative routine records of two nonrandomized nor case-matched groups of patients.In conclusion, it should be apparent that the "carotid sinus denervation by e-CEA" theory is dead.

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Hemodynamic Changes in Chevalier Eversion Versus Conventional Carotid Endarterectomy

Cited by 13 publications

References 39 publications

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

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

Analysis and methods of prevention of cranial nerves injury during carotid endarterectomy

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