Impact of Carotid Artery Revascularization on Cardiovascular Profiles in Patients With Carotid Artery Stenosis

Background: An atheroma developed in the carotid sinus blunts the baroreflex sensitivity and leads to sustained excessive sympathetic nerve activation, resulting in the cardiac dysfunction and abnormal blood pressure profile. This study investigated whether carotid artery revascurization (CAR) can improve cardiac function and the blood pressure profile. Methods: Consecutive 14 patients with the carotid artery stenosis who were scheduled for CAR therapy (carotid endarterectomy or stenting) were enrolled. The echocardiographic, [123I] MIBG-scintigraphic, ambulatory blood pressure monitoring data and biomarkers were obtained at 3-month after CAR, and were compared with preoperative data. Results: After 3 months' follow-up no obvious changes in end-diastolic left ventricular (LV) dimension and LV ejection fraction were observed. However, tissue Doppler-derived e′ increased from 5.4 ± 1.6 cm/s to 6.5 ± 1.8 cm/s, and E/e′ significantly decreased from 12.1 ± 3.8 to 9.1 ± 2.2 (P < .05). These results implies the improvement of the diastolic dysfunction. In 24-hour blood pressure analysis, Standard deviation of SBP after CAR was significantly lower when compared to preoperative data (from 18.6 ± 3.1 to 15.6 ± 3.9, P < .05). In MIBG scintigraphy, H/M ratio in early phase after CAR was significantly higher than that before CAR (from 2.68 ± 0.51 to 2.86 ± 0.56, P < .05). Conclusion: CAR improves the diastolic function and systolic blood pressure variability, which are mediated in part by modified cardiac sympathetic nerve activity.