Altered blood pressure responses of carotid endarterectomy in patients with contralateral carotid artery lesion

Background: In this study, we evaluated altered blood pressure responses within the first three days following carotid endarterectomy in patients with contralateral carotid artery lesion. Methods: A total of 111 patients (52 males, 59 females; mean age 67.7 +/- 8.6 years; range 46 to 83 years) who underwent carotid endarterectomy between March 2009 and November 2012 were retrospectively analyzed. The patients were divided into two groups: those with a patent contralateral carotid artery (group 1, n=65) and those with a contralateral carotid artery stenosis (50% to 99%) or occlusion (group 2, n=44). The changes of the blood pressure compared to the baseline during the postoperative course were analyzed and compared between the groups. Results: In the postoperative period, group 2 patients had significantly higher systolic, diastolic, and mean arterial blood pressure values, compared to group 1 (p<0.05). During the postoperative period, the need for intravenous antihypertensive drugs was significantly higher in group 2, compared to group 1 (p<0.05). The dose of existing antihypertensive medications during hospitalization increased or additional antihypertensive medication was prescribed in 25 patients (56.8%) in group 2 and 14 patients (21.5%) in group 1 after carotid endarterectomy (p<0.05). In group 2, one patient experienced a neurological complication involving a transient ischemia attack. No significant postoperative neurological, surgical, or cardiac complications developed in any patient in either group. Conclusion: The present study showed that the patients scheduled for carotid endarterectomy were at high risk for postoperative hypertension in the presence of a stenosis (50 to 99%) or occlusion of the contralateral internal carotid artery.