Advertisement

Clinical Autonomic Research

, Volume 14, Issue 2, pp 72–79 | Cite as

Long-term effects of unilateral carotid endarterectomy on arterial baroreflex function

  • Henri J. L. M. Timmers
  • Frans G. M. Buskens
  • Wouter Wieling
  • John M. Karemaker
  • Jacques W. M. Lenders
RESEARCH ARTICLE

Abstract.

Background and purpose:

Carotid endarterectomy (CE) may be complicated by the clinical syndrome of baroreflex failure. Alterations of baroreflex function may also account for the frequently observed blood pressure lability in the first hours following surgery. We investigated the long-term effects of unilateral CE on baroreflex control of function and blood pressure.

Methods:

We investigated 14 patients after unilateral CE (13m:1f, 64.8 ± 6.5 years), 9 patients with a surgically untreated uni-/bilateral carotid stenosis (CS, 7m:2f, 57.6 ± 10.7 years) and 12 healthy controls (HC, 11m:1f, 60.9 ± 7.9 years) by means of Valsalva maneuver, active standing, forced breathing, cold face test, cold pressor test and mental arithmetic. Ambulatory blood pressure level and variability were determined from 24-hour Spacelabs and 5-hour beat-to-beat Portapres recordings.

Results:

Baroreflex sensitivity (derived from phase IV Valsalva maneuver) was significantly lower in CE (1.53 ± 0.83 ms/mmHg) than in CS (4.39 ± 2.27, p = 0.002) and HC (5.34 ± 3.78, p = 0.003). CE patients exhibited a decreased reflex control of heart rate in response to Valsalva’s maneuver and active standing without orthostatic hypotension. Office blood pressure levels before and after endarterectomy were similar, as were ambulatory blood pressure levels in the three groups. Ambulatory blood pressure variability was higher in CE and CS than in HC, but not different between CE and CS.

Conclusions:

Unilateral CE causes a long-term impairment of baroreflex function, resulting in an attenuated reflex control of heart rate, but no hypertension or blood pressure lability.

Key words

baroreflex carotid sinus endarterectomy carotid artery disease carotid stenosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • Henri J. L. M. Timmers
    • 1
  • Frans G. M. Buskens
    • 2
  • Wouter Wieling
    • 3
  • John M. Karemaker
    • 4
  • Jacques W. M. Lenders
    • 1
  1. 1.Dept. of General Internal MedicineUniversity Medical Center NijmegenHB NijmegenThe Netherlands
  2. 2.Dept. of Vascular SurgeryUniversity Medical Center NijmegenNijmegenThe Netherlands
  3. 3.Dept. of Internal MedicineAcademic Medical CenterAmsterdamThe Netherlands
  4. 4.Dept. of PhysiologyAcademic Medical CenterAmsterdamThe Netherlands

Personalised recommendations