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Randomized Controlled Trial
. 2024 Dec 5;14(1):30299.
doi: 10.1038/s41598-024-81105-7.

Comparison of the impact of carotid endarterectomy and stenting on autonomic and baroreflex regulations: a one-year follow-up randomized study

Vlasta Bari  1   2 , Giovanni Nano  1   3 , Irene Baroni  4 , Giada De Angeli  5 , Beatrice Cairo  1 , Francesca Gelpi  1 , Valentina Ceserani  6 , Michele Conti  6   7 , Francesco Secchi  1   8 , Alberto Porta  1   2 , Daniela Mazzaccaro  3
Affiliations
Randomized Controlled Trial

Comparison of the impact of carotid endarterectomy and stenting on autonomic and baroreflex regulations: a one-year follow-up randomized study

Vlasta Bari et al. Sci Rep. .

Abstract

Patients with carotid stenosis can receive indication for either carotid endarterectomy (CEA) or carotid artery stenting (CAS), with both techniques having an impact on the autonomic function and baroreflex control.Seventy carotid stenosis patients randomly assigned to CEA or CAS were enrolled. After exclusion of some recordings, 33 CEA (age 67.79 ± 5.32 yrs, 26 males) and 25 CAS (age 70.32 ± 3.63 yrs, 14 males) were admitted to analysis. Autonomic and baroreflex sensitivity markers were derived from the analysis of heart period and systolic arterial pressure spontaneous variability derived in supine position and during active standing (STAND), before (PRE) the intervention and after a 6 and 12-month follow-up (FU6, FU12).CEA had a preserved response of autonomic and baroreflex control to STAND in PRE and FU6, suggesting an early improvement. CAS had a similar response at PRE but a blunted one at the follow-ups. When directly compared, the two groups had a similar autonomic function, with CAS having a reduced baroreflex control in PRE and lower autonomic function at FU6. All the differences disappeared at the long-term follow-up, showing a similar long term effect of the surgical procedures, suggesting that CEA and CAS induced a similar long-term impairment of autonomic and baroreflex controls.

Keywords: Autonomic nervous system; Baroreflex; Cardiovascular risk; Carotid artery endarterectomy; Carotid artery stenting; Heart rate variability.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The procedure of CAS (A) and CEA (B) are illustrated. Briefly, the carotid angiography (A1) showing the stenosis at the origin of the internal carotid artery, then in (A2) the placement of the stent with resolution of the stenosis. In (B1), the carotid bifurcation is exposed after a laterocervical longitudinal incision, then after clamping the bifurcation is opened (B2), the plaque is removed (B3) and then the flow is restored after surgical closure of the arteriotomy (B4).
See this image and copyright information in PMC

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