Influence of blood pressure variability before carotid endarterectomy in postoperative cerebral perfusion changes in patients with carotid artery stenosis / 中华神经医学杂志

ABSTRACT

Objective:To investigate whether the fluctuation of blood pressure variability (BPV) before carotid endarterectomy (CEA) is related to postoperative cerebral perfusion changes in patients with carotid artery stenosis.Methods:A prospective observational cohort study was performed. Forty-seven patients with carotid artery stenosis accepted CEA in Department of Neurosurgery, Guangdong Provincial People's Hospital Affiliated to Southern Medical University from January 2019 to December 2022 were chosen. Patients' blood pressure was closely monitored 3 d before surgery (4 times/d) to obtain their BPV (the maximum △, based on the maximum absolute differences between systolic or diastolic blood pressures measured continuously during the observation period). At the same time, the changes of cerebral perfusion 3 d after surgery were monitored (criteria of cerebral hyperperfusion newly-appeared delirium and hyperactivity after anesthesia resuscitation or intracranial hemorrhage found by imaging examination; criteria of cerebral hypoperfusion newly-appeared speech and motor function deficits or aggravation of original cerebral ischemia symptoms after anesthesia resuscitation, or new-found cerebral infarction by imaging examination). Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of BPV before CEA in postoperative cerebral perfusion changes.Results:In these 47 patients, 9 patients (19.1%) had postoperative cerebral perfusion changes 2 had neurological deficits due to postoperative cerebral infarction, and the other 7 had short-term postoperative delirium or focal neurological deficits (returned to normal after appropriate adjustment of blood pressure). Area under the ROC curve (AUC) of BPV before CEA in predicting postoperative cerebral perfusion changes was 0.876 ( P=0.001, 95% CI 0.775-0.977). These 47 patients were divided into high BPV group ( n=16) and low BPV group ( n=31) according to the optimal index threshold (27.00), and the statistics showed that significant difference in incidence of cerebral perfusion changes after CEA was noted between the 2 groups ( P<0.05); incidence of postoperative cerebral perfusion changes in the high BPV group was 15.5 times higher than that in the low BPV group ( RR=15.500, P<0.001, 95% CI 2.120-113.320). Conclusion:BPV before CEA in patients with carotid artery stenosis can well predict the occurrence of postoperative cerebral perfusion changes.