Avoidance of postcarotid endarterectomy hypertension.

To minimize extreme blood pressure changes after carotid endarterectomy, dissection methods were developed to preserve the intercarotid neural bundle supplying the carotid baroreceptors and applied to our last 90 consecutive carotid endarterectomies. Hypertension was defined as a rise in systolic blood pressure greater than 40 mmHg and hypotension as a drop of 40 mmHg in those with preoperative hypertension or a systolic blood pressure of less than 100 mmGh. There were 46 cases hypertensive before operation, and the remaining 44 were normotensive before operation. When the series was analyzed, half the patients undergoing nerve-sparing dissection became hypotensive, irrespective of pre-existing hypertension extent and bilaterality of stenoses, and preoperative neurologic deficits. Hypotension was a transient and benign process and easily controlled by catheter instillation of 2% xylocaine in the postoperative period. Hypertension, which occurred in ten patients, was equally benign; only five required treatment. There were no deaths or neurologic deficits. Nerve-sparing carotid dissection and catheter placement for block of the carotid sinus nerves are valuable methods to minimize extreme blood pressure changes after carotid endarterectomy.