OBJECTIVE: Blood pressure (BP) instability after carotid endarterectomy (CEA) is a risk factor for @entity65 . The role of the operative technique in the development of post-CEA hemodynamic instability is unclear. The primary goal of this study was to systematically review the literature to determine whether @entity101 in the early postoperative period is dependent on the surgical technique used. METHODS: We searched MEDLINE, Cochrane CENTRAL, and Web of Science through June 2016 without restrictions to language or starting date. The interventions of interest were eversion CEA (E-CEA) compared with conventional CEA (C-CEA) with or without patch plasty. The primary outcome of interest was the incidence of postoperative need for vasodilator therapy because of @entity101 in the early postoperative period, the duration of which was predefined in the individual studies. Secondary outcomes were the intergroup mean difference of the mean within-group changes of postoperative (24  hours) to baseline systolic BP, the incidence of @entity551 requiring vasopressor therapy, and the rate of complications. The odds ratio (OR) of each binary outcome was pooled across studies with its 95% confidence interval (CI). For meta-analysis of continuous outcomes, the weighted mean differences with the corresponding 95% CIs were pooled. Strength of evidence of the outcomes was judged according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS: We identified six studies, of which four were nonrandomized prospective and two retrospective with low to moderate risk of bias. In addition, results of a post hoc analyses of a randomized controlled trial were included, resulting in a total number of seven included studies. Duration of the postoperative study period ranged from 1 to 6  days. The meta-analysis of all studies regarding the primary outcome demonstrated increased rates of post-CEA @entity101 after E-CEA (pooled OR, 2.75; 95% CI, 1.82-4.16; I(2)  = 49.9%). The pooled weighted intergroup mean difference between the E-CEA and C-CEA effects on postoperative systolic BP was  +12.92  mm Hg (95% CI, 8.06-17.78; I(2)  = 93.6%; P  < .0001). @entity551 was significantly higher in the C-CEA group (pooled OR, 11.37; 95% CI, 1.95-66.46; I(2)  = 0%). There was no difference in postoperative complications including @entity583 , @entity64 , neck @entity1410 , or @entity204 . Strength of evidence contributing to the primary outcome as well as the @entity551 outcome was graded as moderate and that contributing to the other secondary outcomes was graded as very low. CONCLUSIONS: E-CEA increases the risk for post-CEA @entity101 , whereas C-CEA is more often associated with @entity551 , Careful BP monitoring at least in the early postoperative period after CEA is mandatory, especially when the eversion technique is used.

Systematic review and meta-analysis of postcarotid endarterectomy XXXX after eversion versus conventional carotid endarterectomy.

@entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension'] @entity1410 :: ('MESH:D006406', 'Disease') :: ['hematoma'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity551 :: ('MESH:D007022', 'Disease') :: ['Hypotension', 'hypotension'] @entity65 :: ('MESH:D002318', 'Disease') :: ['cerebrovascular and cardiovascular complications']
@entity101 :: (MESH:D006973,Disease) :: ['hypertension']
