Postoperatively, the patient went to theatre recovery for 4 hours for close neurological and intra-arterial blood pressure monitoring. The patient had stable systolic blood pressures ranging 180mmHg-200mmHg, without any complaints of headache or neurological deficits.
Hereafter, the systolic blood pressures ranged 120-140mmHg, still without any complaints of headache or neurological deficits and whereafter he was transferred to the vascular ward for hourly non-invasive blood pressure and neurological monitoring.
Post-CEA hypertension can affect up to two thirds of patients and needs to be treated instantly since poorly treated post-CEA is associated with increased rates of TIA/stroke and a risk factor for neck haematoma, hyperperfusion syndrome and intra-cranial haemorrhage.
Read more about post CEA hypertension, its risks and recommendations for management in the 2023 ESVS guidelines:
Read more about pre-operative parameters associated with post-carotid endarterectomy hypertension.
Read more about a large prospective study identifying three strategies for preventing stroke and death following carotid endarterectomy which are readily transferable into surgical practice.
If a new (or worsened) neurological deficit occurs after uneventful recovery from anaesthesia it is recommended to perform rapid imaging before re-exploration following a Delphi consensus. Further details about the need for acute re-exploration can be found in the following video:
ESVS 5th ESVS Masterclass – Day 2 – Carotid (Acute & emergency surgery) (18.32 – 21.40)
