Long-Term Hemodynamic Effects After Carotid Artery Revascularization
| Autor: | Sungho Lim, Carlos F. Bechara, Paul Crisostomo, Sean P. Nassoiy, Pegge Halandras, Yaeji Park, Michael J. Javorski, Bernadette Aulivola |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Baroreceptor medicine.medical_treatment Hemodynamics Blood Pressure Carotid endarterectomy 030204 cardiovascular system & hematology Revascularization 03 medical and health sciences 0302 clinical medicine Heart Rate Internal medicine medicine Humans Autonomic dysregulation Carotid Stenosis Autoregulation 030212 general & internal medicine Antihypertensive Agents Aged Retrospective Studies Aged 80 and over Endarterectomy Carotid business.industry General Medicine Baroreflex Middle Aged Carotid Arteries Treatment Outcome medicine.anatomical_structure Hypertension Cardiology Female Stents Surgery Carotid body Carotid stenting Cardiology and Cardiovascular Medicine business Angioplasty Balloon |
| Zdroj: | Vascular and Endovascular Surgery. 53:297-302 |
| ISSN: | 1938-9116 1538-5744 |
| DOI: | 10.1177/1538574419828088 |
| Popis: | Objective: 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. Methods: 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. Results: 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. Conclusion: 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. |
| Databáze: | OpenAIRE |
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