Application and efficacy of induced hypertension and hypotension in carotid endarterectomy

Objective To evaluate the safety and efficacy of induced hypotension and hypotension in carotid endarterectomy (CEA). Methods Data of 1 486 patients who underwent CEA in multicenters from Aug 2012 to Aug 2018 were retrospectively analyzed. After screening, a total of 1 448 patients met the inclusion criteria. Induced hypertension and hypotension was used in all thees patients. Results 87.8% of the patients were with severe carotid stenosis. The average operative time was (51.8±6.1) min, and the internal carotid artery clamping time was (11.4±3.1) min. After induced hypertension, the stump pressure were higher than that before, of which 1 438 (99.3%) were greater than 50 mmHg. Monitoring of EEG oxygen saturation showed that the value of ipsilateral rSO2 was significantly lower than that of the contralateral [(56%±3%) vs.(64%±4%), P 0.05). Perioperative cerebral infarction occurred in 2 cases, ipsilateral cerebral hemorrhage in 1 case, contralateral cerebral hemorrhage in 1 case and myocardial infarction in 2 cases. Conclusion The technique of induced hypotension and hypotension play a temporary role in brain protection for patients undergoing CEA. This study demonstrated the safety and effectiveness of induced hypertension and hypotension technique. Key words: Endarterectomy , carotid; Circle of Willis; Induced hypertension/hypotension; Stump pressure