Μεταβολές στην ευαισθησία των τασεοϋποδοχέων του ΑΝΣ σε ασθενείς μετά από ενδαρτηρεκτομή των καρωτίδων και συσχέτιση των ευρημάτων με την υπερηχογραφική εικόνα και τα χαρακτηριστικά της αθηρωσκληρωτικής πλάκας

Abstract

Background: The net effect of unilateral carotid endarterectomy (CEA), on baroreflex sensitivity, depends on the counteraction of various suggested mechanisms. Aim: To investigate if the morphology of carotid plaque is another factor that can affect baroreflex function. Methods: Forty-two patients (27 male; mean age 69.09 years) were evaluated. Patients were classified into 2 groups, preoperatively, according to the echogenicity of the plaque, (Gray-Waele classification). Plaques of grades 1 and 2 were defined as echolucent plaques and those of grades 3 and 4 were defined as echogenic. All patients were subjected to elective CEA, using ultraluminal carotid shunt and vein patch. Spontaneous baroreflex sensitivity (sBRS), as a reliable index of responsiveness of the baroreflex, was calculated with the sequence method. Preoperative patient characteristics were compared using the x2 test, Fisher’s exact test, or the independent samples t test. We evaluated hemodynamic parameters, without taking into account the echogenicity of the plaque, using Friedman and Wilcoxon tests. Hemodynamic parameters between the 2 groups of plaques were calculated with multiple and simple analysis of covariance. Results: Patients with echolucent plaques had diabetes mellitus and symptomatic plaques at a significantly greater incidence ( 2=8.077, p=0.004, #ι 2=8.576, p=0.003 respectively). There was an overall reducing of sBRS after CEA, ( 2=32.605, p<0,001). Before endarterectomy, sBRS was greater in patients with echolucent plaques, compared to patients with echogenic plaques (F=10.065, p=0.003). Postoperatively this difference was eliminated. Conclusions: Only preoperatively echogenicity can affect baroreflex function in patients with carotid artery disease. This finding has a special clinical impact in these patients.