Elective Carotid Endarterectomy (Cea) And Carotid Artery Stenting (Cas) - Comparison Of Autonomic Outcome After Elective Carotid Revascularization

OBJECTIVE: To assess the impact of intervention (CEA vs. CAS) on global autonomic function indicated by heart rate variability (HRV), chemoreflex sensitivity (CRS) and baroreflex sensitivity (BRS) under consideration of pre-interventional autonomic state, presence of bilateral stenosis and age. BACKGROUND: Validation of carotid revascularization focuses on stroke prevention. CEA and CAS do not evidently differ in the prevention of stroke in patients with asymptomatic extracranial internal carotid stenosis (Bonati, 2012). Carotid stenosis interferes with carotid baro- and chemoreceptor function and results in autonomic dysfunction (Doux, 2005). Autonomic dysfunction strongly predicts cardio- and cerebrovascular morbidity and mortality (Binici, 2011; Tsuji, 1996). Autonomic function after elective carotid revascularization has never been systematically examined. DESIGN/METHODS: Examination of autonomic function (HRV, CRS, BRS) in 42 patients with >=70% asymptomatic extracranial carotid stenosis prior and four weeks after elective carotid revascularization (CEA n=24, CAS n=18). RESULTS: In patients with CEA compared to patients with CAS, post-interventional total HRV was higher (p CONCLUSIONS: Improvement of autonomic function is superior after CEA compared to CAS. Further determinants of post-interventional autonomic function are pre-interventional autonomic state and presence of bilateral stenosis. Improvement of autonomic function after CEA is primarily based on restoration of chemoreceptor but not on baroreceptor function and is potentially beneficial for cardio- and cerebrovascular long-term outcome. Supported by: Reinhard-Loewenstein-Foundation. Disclosure: Dr. Rupprecht has received research support from Novartis. Dr. Finn has nothing to disclose. Dr. Schultze has nothing to disclose. Dr. Witte has received personal compensation for activities with Desitin and UCB. Dr. Nowack has nothing to disclose. Dr. Hoyer has nothing to disclose. Dr. Schwab has received personal compensation for activities with Biogen, Novartis, Teva, Merck Serono, and Bayer as advisory board and speaker. Dr. Schwab has received research support from Novartis.