During postoperative monitoring, hypotension may occur but the majority of patients, however, develop post-operative hypertension. Strict blood pressure regulation with antihypertensive drugs is paramount to prevent hyperperfusion syndrome, especially in patients with contralateral internal carotid artery occlusion or severe stenosis. In the evening post-surgery or the next day patients usually are able to continue their preoperative antihypertensive drugs. However, sometimes intravenous administration agents such as sodium nitroprusside or nitroglycerine are necessary to quickly effectuate a lower systolic blood pressure.
Read more about the recommendations for managing post-endarterectomy hypertension and hyperperfusion syndrome in the 2023 ESVS guidelines:
Peri- and postoperative antiplatelet and anticoagulation strategies depend on the procedure (CEA, CAS), thromboembolic risk, bleeding risk, type of anticoagulant (vitamin K antagonist [VKA] or DOAC), renal function, and whether bridging anticoagulation is required.
See for reference figure 4,5 and 6 from the ESVS guideline on anticoagulation strategies.
Source: Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2023 Jan;65(1):7-111. doi: 10.1016/j.ejvs.2022.04.011. (pages 40-41)
