{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:44:43Z","timestamp":1791186283582,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila through the institutional program Publish not Perish"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Carotid endarterectomy is a recognized method for preventing stroke for both symptomatic and asymptomatic hemodynamically carotid artery stenosis. Hemodynamic depression is more frequently associated with carotid artery stenting, while postoperative hypertension and cerebral hyperperfusion syndrome are known frequent complications after carotid endarterectomy. Severe hypotension after carotid revascularization is associated with a higher risk of perioperative stroke, myocardial infarction, and death, with limited data existing regarding risk factors. This study aims to investigate intraoperative risk factors for severe hypotension after carotid endarterectomy. Methods: A total of 160 patients who underwent carotid endarterectomy were included in this study. Patients with other cardiac conditions that required concomitant cardiac surgery, patients with incomplete medical records, and patients considered high risk for surgery were excluded. Results: The incidence of severe hypotension was 30.6%. Patients with severe hypotension after carotid endarterectomy had a higher incidence of diabetes, moderate mitral valve regurgitation, a history of percutaneous coronary intervention, and higher operative times. Using logistic regression, temporary shunt insertion was independently associated with severe postoperative hypotension (OR = 2.26, 95% CI = 1.09\u20134.71, p = 0.029). Conclusions: This result favors the selective shunting strategy when performing carotid endarterectomies, especially for those patients with comorbidities predisposing to postoperative complications.<\/jats:p>","DOI":"10.3390\/life14111435","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T09:16:51Z","timestamp":1730884611000},"page":"1435","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Operative Factors Associated with Severe Hypotension in the Postoperative Setting in Patients with Carotid Artery Endarterectomy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3599-129X","authenticated-orcid":false,"given":"Mircea","family":"Robu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina-Maria","family":"Margarint","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Stiru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea Raluca","family":"Hanganu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad","family":"Ichim","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5340-8929","authenticated-orcid":false,"given":"Gabriel-Petre","family":"Gorecki","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miruna","family":"Guzu","sequence":"additional","affiliation":[{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Mazilu","sequence":"additional","affiliation":[{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9069-2722","authenticated-orcid":false,"given":"Vlad Anton","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horatiu","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"},{"name":"Academy of Romanian Scientists, 50711 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1161\/CIR.0b013e31820d8d78","article-title":"2011 ASA\/ACCF\/AHA\/AANN\/AANS\/ACR\/ASNR\/CNS\/SAIP\/SCAI\/SIR\/SNIS\/SVM\/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: Executive summary. A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery","volume":"124","author":"Brott","year":"2011","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/S0140-6736(54)90544-9","article-title":"Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia","volume":"267","author":"Eastcott","year":"1954","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/S0039-6109(05)70356-X","article-title":"Carotid endarterectomy","volume":"78","author":"Riggs","year":"1998","journal-title":"Surg. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett, H.J.M., Taylor, D.W., Haynes, R.B., Sackett, D.L., Peerless, S.J., Ferguson, G.G., Fox, A.J., Rankin, R.N., and Hachinski, V.C. (1991). Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N. Engl. J. Med., 325, 445\u2013453.","DOI":"10.1056\/NEJM199108153250701"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1161\/01.STR.26.1.188","article-title":"Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association","volume":"26","author":"Moore","year":"1995","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ejvs.2022.04.011","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease","volume":"65","author":"Naylor","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/23969873211012121","article-title":"European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis","volume":"6","author":"Bonati","year":"2021","journal-title":"Eur. Stroke J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/ijs.12089","article-title":"Effects of carotid endarterectomy or stenting on hemodynamic complications in the International Carotid Stenting Study: A randomized comparison","volume":"9","author":"Altinbas","year":"2014","journal-title":"Int. J. Stroke"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1148\/radiology.215.3.r00jn04677","article-title":"Postprocedural hypotension after carotid artery stent placement: Predictors and short- and long-term clinical outcomes","volume":"215","author":"Dangas","year":"2000","journal-title":"Radiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1177\/152660280200900614","article-title":"Correlation of periprocedural systolic blood pressure changes with neurological events in high-risk carotid stent patients","volume":"9","author":"Howell","year":"2002","journal-title":"J. Endovasc. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.jvs.2009.05.005","article-title":"Predictors of clinically significant postprocedural hypotension after carotid endarterectomy and carotid angioplasty with stenting","volume":"50","author":"Park","year":"2009","journal-title":"J. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/S1474-4422(05)70251-9","article-title":"Cerebral hyperperfusion syndrome","volume":"4","author":"Rennenberg","year":"2005","journal-title":"Lancet Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100090","DOI":"10.1016\/j.clinsp.2022.100090","article-title":"Hemodynamic depression after carotid surgery: Incidence, risk factors and outcomes","volume":"77","author":"Bogniotti","year":"2022","journal-title":"Clinics"},{"key":"ref_15","first-page":"633","article-title":"Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy","volume":"85","author":"Bove","year":"1979","journal-title":"Surgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3491","DOI":"10.1161\/STROKEAHA.111.624478","article-title":"Effects of carotid endarterectomy or stenting on blood pressure in the International Carotid Stenting Study (ICSS)","volume":"42","author":"Altinbas","year":"2011","journal-title":"Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.jvs.2012.10.141","article-title":"Incidence, predictors, and outcomes of hemodynamic instability following carotid angioplasty and stenting","volume":"58","author":"Ullery","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1093\/eurheartj\/ehu282","article-title":"2014 ESC\/ESA Guidelines on non-cardiac surgery: Cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: Cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA)","volume":"35","author":"Kristensen","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_19","unstructured":"GBD 2019 Stroke Collaborators (2021). Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol., 20, 795\u2013820."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12975-020-00841-w","article-title":"Neurogenesis After Stroke: A Therapeutic Perspective","volume":"12","author":"Rahman","year":"2021","journal-title":"Transl. Stroke Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s13311-023-01352-w","article-title":"Secondary Ischemic Stroke Prevention","volume":"20","author":"Bangad","year":"2023","journal-title":"Neurotherapeutics"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Foerch, C., Schaller-Paule, M.A., Steinmetz, H., Misselwitz, B., and Bohmann, F.O. (2022). Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade. J. Clin. Med., 11.","DOI":"10.3390\/jcm11236942"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.jvs.2013.09.027","article-title":"The effect of ballooning following carotid stent deployment on hemodynamic stability","volume":"59","author":"Qazi","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1016\/j.jacc.2005.08.079","article-title":"Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting","volume":"47","author":"Gupta","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"905","DOI":"10.3171\/2008.9.JNS08509","article-title":"Hemodynamic instability during carotid artery stenting: The relative contribution of stent deployment versus balloon dilation","volume":"110","author":"Lownie","year":"2009","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/j.jvs.2005.02.038","article-title":"Carotid angioplasty and stent-induced bradycardia and hypotension: Impact of prophylactic atropine administration and prior carotid endarterectomy","volume":"41","author":"Cayne","year":"2005","journal-title":"J. Vasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jvir.2007.09.020","article-title":"Influence of stent type on hemodynamic depression after carotid artery stent placement","volume":"19","author":"Diehm","year":"2008","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/153857440303700105","article-title":"Temporary hypotension following endarterectomy for severe carotid stenosis: Should we treat it?","volume":"37","author":"Gibbs","year":"2003","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.surneu.2007.07.006","article-title":"Periprocedural hemodynamic instability with carotid angioplasty and stenting","volume":"70","author":"Taha","year":"2008","journal-title":"Surg. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.jvs.2007.07.020","article-title":"Factors associated with hypotension and bradycardia after carotid angioplasty and stenting","volume":"46","author":"Lin","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1177\/17474930231190837","article-title":"Incidence and risk factors for hypotension after carotid artery stenting: Systematic review and meta-analysis","volume":"19","author":"Yang","year":"2024","journal-title":"Int. J. Stroke"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.avsg.2018.06.005","article-title":"Predicting Factors Associated with Postoperative Hypotension following Carotid Artery Stenting","volume":"54","author":"Rubio","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"106589","DOI":"10.1016\/j.clineuro.2021.106589","article-title":"Factors associated with hemodynamic instability following carotid artery stenting","volume":"203","author":"Choi","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s00701-006-0752-2","article-title":"Hemodynamic instability after extracranial carotid stenting","volume":"148","author":"Beghi","year":"2006","journal-title":"Acta Neurochir."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1161\/01.STR.30.10.2086","article-title":"Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting","volume":"30","author":"Qureshi","year":"1999","journal-title":"Stroke"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.avsg.2015.03.035","article-title":"Predictors and consequences of hemodynamic instability after carotid artery stenting","volume":"29","author":"Wu","year":"2015","journal-title":"Ann. Vasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"120","DOI":"10.5469\/neuroint.2016.11.2.120","article-title":"Prediction of Prolonged Hemodynamic Instability During Carotid Angioplasty and Stenting","volume":"11","author":"Rhim","year":"2016","journal-title":"Neurointervention"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1227\/01.NEU.0000170541.23101.81","article-title":"Prediction of prolonged postprocedural hypotension after carotid artery stenting","volume":"57","author":"Nonaka","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e23136","DOI":"10.1016\/j.heliyon.2023.e23136","article-title":"Clinical analysis of patients with hemodynamic depression after carotid artery stenting","volume":"9","author":"Wei","year":"2023","journal-title":"Heliyon"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ijscr.2015.07.030","article-title":"Internal carotid artery rupture caused by carotid shunt insertion","volume":"14","author":"Illuminati","year":"2015","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/BF01561267","article-title":"Seventeen-year experience with routine shunting in carotid artery surgery","volume":"3","author":"Javid","year":"1979","journal-title":"World J. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/s10016-006-9037-8","article-title":"Routine shunting is a safe and reliable method of cerebral protection during carotid endarterectomy","volume":"20","author":"Bellosta","year":"2006","journal-title":"Ann. Vasc. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Bond, R., Rerkasem, K., and Rothwell, P.M. (2002). Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst. Rev., CD000190.","DOI":"10.1002\/14651858.CD000190"},{"key":"ref_44","first-page":"260","article-title":"Safe intraluminal shunting during carotid endarterectomy","volume":"93","author":"Bandyk","year":"1983","journal-title":"Surgery"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1227\/00006123-198609000-00018","article-title":"Distal cervical carotid dissection after carotid endarterectomy: A complication of indwelling shunt?","volume":"19","author":"Loftus","year":"1986","journal-title":"Neurosurgery"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"305","DOI":"10.26574\/maedica.2020.15.3.305","article-title":"Cardiovascular Complications of Hemolytic Uremic Syndrome in Children","volume":"15","author":"Filip","year":"2020","journal-title":"Maedica"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/11\/1435\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:27:23Z","timestamp":1760113643000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/11\/1435"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,6]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["life14111435"],"URL":"https:\/\/doi.org\/10.3390\/life14111435","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,6]]}}}