Bari Vlasta, Nano Giovanni, Baroni Irene, De Angeli Giada, Cairo Beatrice, Gelpi Francesca, Ceserani Valentina, Conti Michele, Secchi Francesco, Porta Alberto, Mazzaccaro Daniela
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Sci Rep. 2024 Dec 5;14(1):30299. doi: 10.1038/s41598-024-81105-7.
Patients with carotid stenosis can receive indication for either carotid endarterectomy (CEA) or carotid artery stenting (CAS), with both techniques having an impact on the autonomic function and baroreflex control.Seventy carotid stenosis patients randomly assigned to CEA or CAS were enrolled. After exclusion of some recordings, 33 CEA (age 67.79 ± 5.32 yrs, 26 males) and 25 CAS (age 70.32 ± 3.63 yrs, 14 males) were admitted to analysis. Autonomic and baroreflex sensitivity markers were derived from the analysis of heart period and systolic arterial pressure spontaneous variability derived in supine position and during active standing (STAND), before (PRE) the intervention and after a 6 and 12-month follow-up (FU6, FU12).CEA had a preserved response of autonomic and baroreflex control to STAND in PRE and FU6, suggesting an early improvement. CAS had a similar response at PRE but a blunted one at the follow-ups. When directly compared, the two groups had a similar autonomic function, with CAS having a reduced baroreflex control in PRE and lower autonomic function at FU6. All the differences disappeared at the long-term follow-up, showing a similar long term effect of the surgical procedures, suggesting that CEA and CAS induced a similar long-term impairment of autonomic and baroreflex controls.
颈动脉狭窄患者可接受颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS），这两种技术都会对自主神经功能和压力反射控制产生影响。纳入了70例随机分配接受CEA或CAS的颈动脉狭窄患者。排除一些记录后，33例接受CEA的患者（年龄67.79±5.32岁，男性26例）和25例接受CAS的患者（年龄70.32±3.63岁，男性14例）纳入分析。自主神经和压力反射敏感性标志物来自于对仰卧位和主动站立（STAND）期间心脏周期和收缩期动脉压自发变异性的分析，分别在干预前（PRE）以及6个月和12个月随访后（FU6、FU12）进行。CEA在PRE和FU6时对主动站立的自主神经和压力反射反应保持不变，提示早期改善。CAS在PRE时反应相似，但在随访时减弱。直接比较时，两组自主神经功能相似，CAS在PRE时压力反射控制降低，在FU6时自主神经功能较低。长期随访时所有差异均消失，表明手术操作的长期效果相似，提示CEA和CAS对自主神经和压力反射控制造成的长期损害相似。
