Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Department of Vascular Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany; Medical School Berlin, Berlin, Germany.
Ann Vasc Surg. 2024 Nov;108:393-402. doi: 10.1016/j.avsg.2024.06.008. Epub 2024 Jul 15.
Carotid endarterectomy (CEA) is a well-established standard therapy for patients with symptomatic or asymptomatic high-grade carotid stenosis. The aim of carotid endarterectomy is to decrease the risk of stroke and avoid relevant functional loss. However, carotid endarterectomy is known to be associated with hemodynamic dysregulation. In this study we compared eversion CEA (E-CEA) and conventional CEA (C-CEA) regarding postoperative blood pressure values as well as preoperative and postoperative baroreceptor sensitivity in the first 7 days after surgery. The aim was to find possible factors influencing changes in baroreceptor sensitivity.
Patients (111 patients were enrolled, of which 50 patients received C-CEA and 61 patients E-CEA) were prospectively enrolled in this study. For the measurement of baroreceptor sensitivity, a noninvasive Finometer measuring device from Finapres Medical System B.V. (Amsterdam, The Netherlands) was used. Measurements were performed 1 day before surgery (PRE), directly after surgery (F1), on day 1 (F2), day 2 (F3), and on day 7 (F4) postoperatively.
Postoperative blood pressure values were significantly higher in the E-CEA group on the day of surgery (F1) (P < 0.001) and on day 1 (F2) (P < 0.001). From day 2 (F3, F4) postoperatively, no significant difference was found between the 2 groups. The invasive blood pressure measurement in the postoperative recovery room showed significantly higher systolic blood pressure values in the E-CEA group (P = 0.001). The need of acute antihypertensive therapy was significantly higher in the recovery room in the E-CEA group (P = 0.020). With regard to changes in baroreceptor sensitivity, significantly lower baroreceptor sensitivity (BRS) values were recorded in the E-CEA group at 1 day (F2) postoperatively (P = 0.005). The regression analysis showed that the applied surgical technique and the patient's age were significant factors influencing changes in baroreceptor sensitivity.
In this study we could confirm higher blood pressure levels after E-CEA in the first 2 days after surgery. Additionally, we identified 22 factors possibly influencing baroreceptor sensitivity: surgical technique and age. Based on the data obtained in this study, hemodynamic dysregulation after CEA (E-CEA, C-CEA) is temporary and short-term. Already after the second postoperative day, there was no significant difference between the E-CEA and E-CEA groups, this effect remained stable after 7 days.
颈动脉内膜切除术（CEA）是治疗有症状或无症状的高级颈动脉狭窄患者的成熟标准治疗方法。颈动脉内膜切除术的目的是降低中风风险并避免相关的功能丧失。然而，颈动脉内膜切除术与血液动力学失调有关。在这项研究中，我们比较了外翻颈动脉内膜切除术（E-CEA）和传统颈动脉内膜切除术（C-CEA）在手术后前 7 天内的术后血压值以及术前和术后的压力感受器敏感性。目的是寻找可能影响压力感受器敏感性变化的因素。
前瞻性纳入了 111 名患者（其中 50 名接受 C-CEA，61 名接受 E-CEA）进行了这项研究。为了测量压力感受器敏感性，使用了来自 Finapres Medical System B.V.（荷兰阿姆斯特丹）的非侵入性 Finometer 测量设备。在术前 1 天（PRE）、术后即刻（F1）、术后第 1 天（F2）、第 2 天（F3）和第 7 天（F4）进行测量。
E-CEA 组在手术当天（F1）（P < 0.001）和术后第 1 天（F2）（P < 0.001）的术后血压值明显更高。从术后第 2 天（F3，F4）开始，两组之间没有发现显著差异。术后恢复室的有创血压测量显示，E-CEA 组的收缩压明显更高（P = 0.001）。E-CEA 组在恢复室中需要急性降压治疗的比例明显更高（P = 0.020）。在压力感受器敏感性变化方面，E-CEA 组在术后第 1 天（F2）的压力感受器敏感性（BRS）值明显较低（P = 0.005）。回归分析表明，应用的手术技术和患者年龄是影响压力感受器敏感性变化的显著因素。
在这项研究中，我们可以确认 E-CEA 后前 2 天手术后血压水平升高。此外，我们确定了 22 个可能影响压力感受器敏感性的因素：手术技术和年龄。基于这项研究获得的数据，CEA（E-CEA、C-CEA）后的血液动力学失调是暂时的和短期的。在术后第 2 天，E-CEA 组和 C-CEA 组之间就没有显著差异，这种影响在 7 天后仍然稳定。
