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Chirurgie 22. Dezember 2014

Postoperative blood pressure in patients undergoing eversion carotid endarterectomy with or without resection of the carotid sinus nerve

Background: The carotid sinus nerve (CSN) is important for regulation of blood pressure (BP) and heart rate. The aim of our study was to investigate whether dissection of the carotid bifurcation during eversion carotid endarterectomy (eCEA) causes a histologically proven compromise of the CSN and how the postoperative BP was affected thereby.

Methods: Consecutive patients undergoing eCEA for primary high-grade internal carotid artery (ICA) stenosis without contralateral pathology were selected for this study. In all patients, histological specimens of the periadventitial tissue within the carotid bifurcation were taken during eCEA. Nerval structures of the CSN within the carotid bifurcation were detected by immunohistochemistry. BP was continuously monitored postoperatively.

Results: From March 2007 to March 2008, 100 patients were selected. In 55 patients (Group A), nerval structures could be detected within specimens resected during eCEA. In 45 patients (Group B), nerval structures could not be found histologically. Both groups were equal regarding cardiovascular risk factors, degree of ICA stenosis, and indication for surgery. There was a significant difference of diastolic BP values between Group A and B 7 h postoperatively (p = 0.005). We observed a significant difference of mean systolic BP values between both groups 30 days after operation (p = 0.011). All other mean BP values were equal between both groups at any point of time.

Conclusions: Our study showed that eCEA does not always imply a histologically proven compromise of the CSN and that BP is mainly equal in patients with and without histologically proven compromise of the CSN.

K. Linni, M. Aspalter, Doz. D. Neureiter, Doz. W. Hitzl, Prof. H. Magometschnigg, Prof. T. Hölzenbein, European Surgery 6/2014

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