Redefining postoperative hypertension management in carotid surgery: a comprehensive analysis of blood pressure homeostasis and hyperperfusion syndrome in unilateral vs. bilateral carotid surgeries and implications for clinical practice.

Sultan, Sherif; Acharya, Yogesh; Dulai, Makinder; Tawfick, Wael; Hynes, Niamh; Wijns, William; Soliman, Osama

dc.contributor.author	Sultan, Sherif
dc.contributor.author	Acharya, Yogesh
dc.contributor.author	Dulai, Makinder
dc.contributor.author	Tawfick, Wael
dc.contributor.author	Hynes, Niamh
dc.contributor.author	Wijns, William
dc.contributor.author	Soliman, Osama
dc.date.accessioned	2024-12-10T11:41:36Z
dc.date.available	2024-12-10T11:41:36Z
dc.date.issued	2024-04-04
dc.identifier.issn	2296-875X
dc.identifier.pmid	38638141
dc.identifier.doi	10.3389/fsurg.2024.1361963
dc.identifier.uri	http://hdl.handle.net/10147/643680
dc.description	A marked acute elevation in blood pressure was observed in patients undergoing both unilateral and bilateral carotid surgeries (p < 0.001). Smoking (OR: 1.183, p = 0.007), hyperfibrinogenemia (OR: 0.834, p = 0.004), emergency admission (OR: 1.192, p = 0.005), severe ipsilateral carotid stenosis (OR: 1.501, p = 0.022), and prior ipsilateral interventions (OR: 1.722, p = 0.003) emerged as significant factors that correlates with postoperative hypertension in unilateral surgeries. Conversely, in bilateral procedures, gender, emergency admissions (p = 0.012), and plaque morphology (p = 0.035) significantly influenced postoperative hypertension. Notably, 2.2% of bilateral surgery patients developed hyperperfusion syndrome, culminating in hemorrhagic stroke within 30 days. Intriguingly, postoperative stage II hypertension was identified as an independent predictor of neurological deficits post-secondary procedure in bilateral CEA cases (p = 0.004), attributable to hyperperfusion syndrome. However, it did not independently predict myocardial infarction or mortality outcomes. The overall 30-day stroke rate stood at 0.90%. Lowest incidence of post operative hypertension or any complications were observed in eversion carotid endartrertomy.	en_US
dc.language.iso	en	en_US
dc.rights	© 2024 Sultan, Acharya, Dulai, Tawfick, Hynes, Wijns and Soliman.
dc.rights	Attribution 4.0 International	*
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	*
dc.subject	carotid artery stenosis	en_US
dc.subject	carotid endarterectomy	en_US
dc.subject	hyperperfusion syndrome	en_US
dc.subject	HYPERTENSION	en_US
dc.subject	STROKE	en_US
dc.title	Redefining postoperative hypertension management in carotid surgery: a comprehensive analysis of blood pressure homeostasis and hyperperfusion syndrome in unilateral vs. bilateral carotid surgeries and implications for clinical practice.	en_US
dc.type	Article	en_US
dc.identifier.journal	Frontiers in surgery	en_US
dc.source.journaltitle	Frontiers in surgery
dc.source.volume	11
dc.source.beginpage	1361963
dc.source.endpage
refterms.dateFOA	2024-12-10T11:41:37Z
dc.source.country	Switzerland