Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery

Influence of systemic hemodynamics on retrograde pressure in the internal carotid artery during carotid endarterectomy operation

Authors: A.N. Vachev, M.G. Prozhoga, O.V. Dmitriev

Samara State Medical University, Ministry of Health of the Russian Federation, ul. Chapaevskaya, 89, Samara, 443099, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.


UDC: 616.133.3-007.271-089.87:612.14

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (4): 293-298

Quote as: Vachev A.N., Prozhoga M.G., Dmitriev O.V. Influence of systemic hemodynamics on retrograde pressure in the internal carotid artery during carotid endarterectomy operation. Clinical Physiology of Circulation. 2019; 16 (4): 293–8 (in Russ.). DOI: 10.24022/1814-6910-2019-16-4-293-298

Received / Accepted:  17.09.2019/30.09.2019

Full text:  


Objective. To determine the significance of central hemodynamic parameters for collateral compensation of impaired main cerebral blood flow during carotid endarterectomy (CEA).
Material and methods. 100 patients who underwent CEA were examined. Systemic arterial hypertension was used to protect the brain from ischemia. To assess cerebral perfusion during compression of the internal carotid artery (ICA), retrograde pressure measurement in the ICA was used. During pre-cerebral vascular clamping, a parallel invasive control of arterial and retrograde pressures was performed. The retrograde pressure index was calculated. By the value of the index, patients were divided into 3 groups. Conducted an analysis of the correlation of systemic and retrograde pressures.
Results. In 61 (61%) patients, a high correlation was observed between retrograde and systemic pressure indices (correlation degree 0.983–0.995). The remaining 39 (39%) patients showed a reduced correlation, but nevertheless remained within a high degree of dependence (the degree of correlation was 0.673–0.886). In this case, a significant difference in the values of systemic blood pressure was revealed in groups with different retrograde pressure indices (p<0.05). The selected groups significantly differed in the level of retrograde pressure in the ICA (p<0.05).
Conclusion. 1. The retrograde pressure in the ICA depends on the level of systemic blood pressure, this dependence is directly proportional and can be high, medium and low. 2. When performing the CEA operation, a systolic retrograde pressure level above 40 mmHg can be achieved by correcting central hemodynamics at the stage of clamping the internal carotid artery.


  1. Crawford E.S., DeBakey M.E., Blaisdell F.W., Morris G.C. Jr., Fields W.S. Hemodynamic alterations in patients with cerebral arterial insufficiency before and after operation. Surgery. 1960; 48: 76–94. PMID: 13812702
  2. LeSar C.J., Sprouse L.R., Harris W.B. Permissive hypertension during awake eversion carotid endarterectomy: a physiologic approach for cerebral protection. J. Am. Coll. Surg. 2014; 218 (4): 760–6. DOI: 10.1016/ j.jamcollsurg.2013.12.029
  3. Duke B.J., Breeze R.E., Rubenstein D., Tranmer B.I., Kindt G.W. Induced hypervolemia and inotropic support for acute cerebral arterial insufficiency: an underused therapy. Surg. Neurol. 1998; 49 (1): 51–4. DOI: 10.1016/s0090-3019(97)00353-4
  4. Fuhrer H., Weiller C., Niesen W.D. Is mean arterial pressure the best parameter in ischemic stroke? Clin. Case Rep. 2016; 4 (3): 236–9. DOI: 10.1002/ccr3.491
  5. Heyer E.J., Mergeche J.L., Anastasian Z.H., Kim M., Mallon K.A., Connolly E.S. Arterial blood pressure management during carotid endarterectomy and early cognitive dysfunction. Neurosurgery. 2014; 74: 245–51. DOI: 10.1227/NEU.0000000000000256
  6. Kobayashi M., Ogasawara K., Yoshida K., Sasaki M., Kuroda H. et al. Intentional hypertension during dissection of carotid arteries in endarterectomy prevents postoperative development of new cerebral ischemic lesions caused by intraoperative microemboli. Neurosurgery. 2011; 69 (2): 301–7. DOI: 10.1227/ NEU.0b013e318214abf6
  7. Hillis A.E., Ulatowski J.A., Barker P.B., Torbey M., Ziai W., Beauchamp N.J. et al. A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke. Cerebrovasc. Dis. 2003; 16: 236–46. DOI: 10.1159/ 000071122
  8. Stoneham M.D., Warner O. Blood pressure manipulation during awake carotid surgery to reverse neurological deficit after carotid cross-clamping. Br. J. Anaesth. 2001; 87: 641–4. DOI: 10.1093/bja/87.4.641
  9. Wang B.H., Leung A., Lownie S.P. Circle of willis collateral during temporary internal carotid artery occlusion II: observations from computed tomography angiography. Can. J. Neurol. Sci. 2016; 43 (4): 538–42. DOI: 10.1017/cjn.2016.10
  10. Lownie S.P., Larrazabal R., Kole M.K. Circle of willis collateral during temporary internal carotid artery occlusion I: observations from digital subtraction angiography. Can. J. Neurol. Sci. 2016; 43 (4): 533–7. DOI: 10.1017/cjn.2016.9
  11. Бунятян А.А., Селезнев М.Н., Саблин И.Н., Пожарнов А.С. Анестезия и защита мозга при реконструктивных операциях на брахиоцефальных артериях. Анестезиология и реаниматология. 1993; 3: 3–6. [Bunyatyan A.A., Seleznev M.N., Sablin I.N., Pozharnov A.S. Anesthesia and brain protection during reconstructive operations on the brachiocephalic arteries. Russian Journal of Anaesthesiology and Reanimatology. 1993; 3: 3–6 (in Russ.).]
  12. Неймарк М.И., Шмелёв В.В., Симагин В.Ю., Елизарьев А.Ю., Субботин Е.А. Выбор метода анестезии, нейропротекторной терапии в реконструктивной хирургии экстракраниальных сосудов. Общая реаниматология. 2011; 7 (5): 22–7. [Neimark M.I., Shmelev V.V., Simagin V.Yu., Elizarev A.Yu., Subbotin E.A. Choice of anesthesia mode, neuroprotective therapy in the surgical repair of extracranial vessels. General Reanimatology. 2011; 7 (5): 22–7 (in Russ.).]
  13. Гулешов В.А., Белов Ю.В., Селезнев М.Н. Анестезиологическое обеспечение операций на брахиоцефальных артериях. Кардиология и сердечно-сосудистая хирургия. 2008; 1 (4): 69–74. [Guleshov V.A., Belov Yu.V., Seleznev M.N. Anaesthesiological supply of operations on brachiocephalic arteries. Russian Journal of Cardiology and Cardiovascular Surgery. 2008; 1 (4): 69–74 (in Russ.).]
  14. Ben Ahmed S., Daniel G., Benezit M., Ribal J.P., Rosset E. Eversion carotid endarterectomy without shunt: concerning 1385 consecutive cases. J. Cardiovasc. Surg. (Torino). 2017; 58 (4): 543–50. DOI: 10.23736/ S0021-9509.16.08495-0
  15. Покровский А.В. Клиническая ангиология. М.: Медицина; 2004; 1: 758–9. [Pokrovsky A.V. Clinical angiology. Moscow: Meditsina; 2004; 1: 758–9 (in Russ.).]
  16. Шмигельский А.В., Усачев Д.Ю., Лукшин В.А., Огурцова А.А., Лубнин А.Ю., Сазонова О.Б., Шахнович В.А. Мультимодальный нейромониторинг вранней диагностике ишемии головного мозга при реконструкции сонных артерий. Анестезиология и реаниматология. 2008; 2: 16–21. [Shmigelsky A.V., Usachev D.Yu., Lukshin V.A., Ogurtsova A.A., Lubnin A.Yu., Sazonova O.B., Shakhnovich V.A. Multimodal neuromonitoring in the early diagnosis of brain ischemia during carotid arterial reconstruction. Russian Journal of Anaesthesiology and Reanimatology. 2008; 2: 16–21 (in Russ.).]
  17. Shahidi S., Owen-Falkenberg A., Gottschalksen B. Clinical validation of 40-mmHg carotid stump pressure for patients undergoing carotid endarterectomy under general anesthesia. J. Cardiovasc. Surg. (Torino). 2017; 58 (3): 431–8. DOI: 10.23736/S0021-9509.16. 08173-8

About Authors

  • Aleksey N. Vachev, Dr. Med. Sc., Professor, Chief of Chair and Clinic of Faculty Surgery;
  • Mikhail G. Prozhoga, Postgraduate, Anesthesiologist-Intensivist;
  • Oleg V. Dmitriev, Cand. Med. Sc., Head of Department of Vascular Surgery № 1, Clinics of SSMU;

 If you found mistakes, select text and press Alt+A