Systolic hypertension and complications of carotid endarterectomy.

Systolic hypertension after carotid endarterectomy is frequently a serious problem associated with increased mortality and increased incidence of neurologic deficit. While this association is well reported, the authors of most series have been unable to determine whether the neurologic deficit was the cause or result of postoperative hypertension. From October 1978 to August 1981, 41 consecutive symptomatic patients who had carotid endarterectomy were examined with regard to hypertension control. The incidence of preoperative hypertension was 59%. All hypertension was controlled preoperatively in the hospital. Postoperative incidence of hypertension was 64%. Rigid control of blood pressure during the operative procedure and postoperative period was obtained with sodium nitroprusside. There was no mortality and no patients in this group had neurologic deficits. Our conclusion is that while the success or failure of the carotid endarterectomy is known to be multifactorial, this small group of patients indicates the need for rigid control of blood pressure in improving overall results.