Preditores hemodinâmicos e alterações durante a endarterectomia carotídea sob anestesia regional

Abstract

Objectives: Carotid endarterectomy (CEA) is the standard procedure for treating carotid stenosis, but it can lead to cerebral hypoperfusion and hemodynamic stroke. Regional anesthesia (RA) and light sedation allow continuous monitoring of neurological function during the procedure. However, the relationship between perioperative hemodynamic management and neurological dysfunction has yet to be thoroughly investigated. This study aimed to identify which hemodynamic patterns are most strongly associated with intraoperative cerebral ischemia in patients undergoing CEA under RA. Methods: The study included patients who underwent CEA at an academic tertiary referral center between January 2012 and December 2019. Cases were individuals who developed neurological deficits (ND) during CEA. Controls were patients who did not experience ND. Controls were sampled 1:1 from consecutive patients undergoing the same CEA technique at the same department. Results: A total of 154 patients were included, 78,6% male, and the mean age was 70.1±9.1 years. Cases were older than the controls (p=0.012). Baseline systolic blood pressure (SBP) values were higher in the ND group (154.6±31.8 vs 141.8±41.2 mmHg, p=0.035) as well as pulse pressure (p=0.023). The ND group also had a statistically significant higher mean arterial pressure (MAP) at the 3rd-minute post-clamp (p=0.028) and exhibited a smaller drop in SBP between the pre-clamp and the 1st and 3rd minutes post-clamp (p=0.021 and p=0.039, respectively). Conclusions: Focal neurological deficits during CEA showed no characteristic preditive pattern, besides a higher systolic blood pressure. Hemodynamic management at the pre-clamping stage is crucial for preventing unwanted deficits.