Eversion technique increases the risk for post-carotid endarterectomy hypertension

Objective: The incidence of postoperative hypertension (HTN) after eversion carotid endarterectomy (e-CEA) was compared with that after standard carot id endarterectomy (s-CEA). Methods: In a retrospective analysis from January 1998 to January 2000, 217 patients underwent 219 CEAs for symptomatic (68) or asymptomatic (151) hig h-grade (> 80%) carotid artery stenosis by either standard (137) or eversio n (82) techniques. The eversion technique involves an oblique transection o f the internal carotid artery at the carotid bulb and a subsequent endarter ectomy by everting the internal carotid artery over the atheromatous plaque . Ali procedures were done under general anesthesia, and somatosensory-evok ed potentials were used for cerebral monitoring. Patients with s-CEA were c ompared with those with e-CEA for postoperative hemodynamic instability, ca rotid sinus nerve block, requirement for intravenous vasodilators or vasopr essors, stroke, and death. Results: Patients who underwent c-CEA had a significantly (P < .005) increa sed postoperative blood pressure and required more frequent intravenous ant ihypertensive medication (24%), compared with patients having an s-CEA (6%) . Furthermore, postoperative vasopressors were required after 10% of s-CEAs , but after none of the e-CEAs. No statistically significant difference was noted in the morbidity or mortality of patients after s-CEA and e-CEA. Conclusion: c-CEA is a substantial risk factor for HTN in the immediate pos toperative period, when compared with the s-CEA. This difference would be e ven more remarkable in the absence of antihypertensive medications in the e -CEA group and vasopressors in the s-CEA group. Therefore, particular atten tion should be focused on diagnosing and controlling postoperative HTN in p atients after e-CEA.