Lim Sungho, Javorski Michael J, Nassoiy Sean P, Park Yaeji, Halandras Pegge M, Bechara Carlos F, Aulivola Bernadette, Crisostomo Paul R
1 Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
2 Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Vasc Endovascular Surg. 2019 May;53(4):297-302. doi: 10.1177/1538574419828088. Epub 2019 Feb 11.
The baroreceptor at the carotid body plays an important role in hemodynamic autoregulation. Manipulation of the baroreceptor during carotid endarterectomy (CEA) or radial force from carotid artery angioplasty and/or stenting (CAS) may cause both intraoperative and postoperative hemodynamic instability. The purpose of this study is to evaluate the long-term effects of CEA and CAS on blood pressure (BP), heart rate (HR), and subsequent changes on antihypertensive medications.
A retrospective chart review was performed to identify patients who underwent CEA or CAS between 2009 and 2015 at a single tertiary care institution. Baseline demographics and comorbidities were recorded. Operative details of the carotid artery endarterectomy and the use of balloon angioplasty during the CAS were analyzed. Hemodynamic parameters such as BP, HR, and antihypertensive medication requirement were evaluated at 3, 6, 12, 24, and 36 months.
A total of 289 patients were identified. The average age was 70.6 years old, and males constituted 64.0%. All patients had moderate (>50%) to severe (>70%) carotid stenosis. Of those, 111 (40.5%) patients were symptomatic. Systolic BP (mm Hg) of CAS and CEA were similar over the entire follow-up period. Heart rate (beats/min) remained stable postoperatively. A reduced number of antihypertensive medications was observed in the CAS cohort during the first postoperative year when compared to the preoperative baseline: 2.03 at preop, 1.77 ( P < .01) at 3 months, 1.78 ( P = .02) at 6 months, 1.77 ( P = .02) at 12 months, 1.86 ( P = .09) at 24 months, and 2.03 ( P = =.50) at 36 months. Logistic regression analysis identified that CAS (odds ratio [OR]: 2.52, confidence interval [CI]: 1.09-5.83) and multiple (>2) antihypertensive medication use at baseline (OR: 5.89, CI: 2.62-13.26) were predictors for a reduction in the number of antihypertensive medications following carotid revascularization.
Surgical intervention for carotid stenosis poses a risk of postoperative hemodynamic dysregulation. Although postoperative BP and HR remained relatively stable after both CAS and CEA, the number of postoperative antihypertensive medications was reduced in the CAS cohort for the first postoperative year when compared to baseline. Patients with multiple antihypertensive agents undergoing CAS should have close postoperative BP monitoring and should be monitored for a possible reduction in their antihypertensive medication regimen.
颈动脉体的压力感受器在血流动力学自动调节中起重要作用。在颈动脉内膜切除术（CEA）过程中对压力感受器的操作，或颈动脉血管成形术和/或支架置入术（CAS）产生的径向力，可能导致术中和术后血流动力学不稳定。本研究的目的是评估CEA和CAS对血压（BP）、心率（HR）的长期影响，以及对降压药物后续变化的影响。
进行一项回顾性病历审查，以确定2009年至2015年在一家三级医疗机构接受CEA或CAS的患者。记录基线人口统计学和合并症。分析颈动脉内膜切除术的手术细节以及CAS期间球囊血管成形术的使用情况。在3、6、12、24和36个月时评估血流动力学参数，如BP、HR和降压药物需求。
共确定了289例患者。平均年龄为70.6岁，男性占64.0%。所有患者均有中度（>50%）至重度（>70%）颈动脉狭窄。其中，111例（40.5%）患者有症状。在整个随访期间，CAS和CEA的收缩压（mmHg）相似。术后心率（次/分钟）保持稳定。与术前基线相比，CAS队列在术后第一年使用的降压药物数量减少：术前为2.03种，3个月时为1.77种（P<.01），6个月时为1.78种（P=.02），12个月时为1.77种（P=.02），24个月时为1.86种（P=.09），36个月时为2.03种（P=.50）。逻辑回归分析确定，CAS（比值比[OR]：2.52，置信区间[CI]：1.09-5.83）和基线时使用多种（>2种）降压药物（OR：5.89，CI：2.62-13.26）是颈动脉血运重建后降压药物数量减少的预测因素。
颈动脉狭窄的手术干预存在术后血流动力学失调的风险。尽管CAS和CEA术后BP和HR均保持相对稳定，但与基线相比，CAS队列在术后第一年的术后降压药物数量减少。接受CAS的使用多种降压药物的患者术后应密切监测BP，并应监测其降压药物治疗方案是否可能减少。
