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. 2014 Mar;74(3):245-51; discussion 251-3.
doi: 10.1227/NEU.0000000000000256.

Arterial blood pressure management during carotid endarterectomy and early cognitive dysfunction

Eric J Heyer  1 , Joanna L Mergeche, Zirka H Anastasian, Minjae Kim, Kaitlin A Mallon, E Sander Connolly
Affiliations

Arterial blood pressure management during carotid endarterectomy and early cognitive dysfunction

Eric J Heyer et al. Neurosurgery. 2014 Mar.

Expression of concern in

  • Editorial Expression of Concern.
    [No authors listed] [No authors listed] Neurosurgery. 2023 Aug 1;93(2):489. doi: 10.1227/neu.0000000000002565. Epub 2023 Jun 9. Neurosurgery. 2023. PMID: 37293834 No abstract available.

Abstract

Background: A common practice during cross-clamp of carotid endarterectomy (CEA) is to manage mean arterial pressure (MAP) above baseline to optimize the collateral cerebral blood flow and reduce the risk of ischemic stroke.

Objective: To determine whether MAP management ≥20% above baseline during cross-clamp is associated with lower risk of early cognitive dysfunction, a subtler form of neurological injury than stroke.

Methods: One hundred eighty-three patients undergoing CEA were enrolled in this ad hoc study. All patients had radial arterial catheters placed before the induction of general anesthesia. MAP was managed at the discretion of the anesthesiologist. All patients were evaluated with a battery of neuropsychometric tests preoperatively and 24 hours postoperatively.

Results: Overall, 28.4% of CEA patients exhibited early cognitive dysfunction (eCD). Significantly fewer patients with MAP ≥20% above baseline during cross-clamp exhibited eCD than those managed <20% above (11.6% vs 38.6%, P < .001). In a multivariate logistic regression model, MAP ≥20% above baseline during the cross-clamp period was associated with significantly lower risk of eCD (odds ratio [OR], 0.18 [0.07-0.40], P < .001), whereas diabetes mellitus (OR, 2.73 [1.14-6.61], P = .03) and each additional year of education (OR, 1.19 [1.06-1.34], P = .003) were associated with significantly higher risk of eCD.

Conclusion: The observations of this study suggest that MAP management ≥20% above baseline during cross-clamp of the carotid artery may be associated with lower risk of eCD after CEA. More prospective work is necessary to determine whether MAP ≥20% above baseline during cross-clamp can improve the safety of this commonly performed procedure.

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Figures

Figure 1
Figure 1
Bar graph of the incidence of eCD by MAP management during cross-clamp; y-axis is the percentage of patients with eCD and x-axis is the MAP percentage range during cross-clamp relative to baseline. Values above each bar is the respective number of patients with eCD in the management group/total number of patients managed in that management group, and the percentage of eCD. Error bars represent 95% confidence intervals.
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