![]() ![]() decrease MAP prior to cross-clamp release to avoid hyperperfusion and intimal tear. ![]() increase MAP during cross-clamp placement to promote contralateral cerebral blood flow through the circle of Willis.maintain mean arterial pressure (MAP) close to baseline.Intraoperative hemodynamic goals include:.Surgical manipulation of the carotid sinus during CEA or stenting can cause abrupt activation of the baroreceptors leading to bradycardia and hypotension mediated through the baroreceptor reflex arc (Figure 2).Revascularization can be considered after neurological recovery. Guidelines recommend against revascularization in patients who have experienced disabling strokes or have altered consciousness.Carotid stenting over CEA may be beneficial for high surgical risk patients or for patients with unfavorable neck anatomy.In patients with a recent nondisabling stable stroke, carotid revascularization should be performed after 48 hours but within 14 days of stroke to achieve the greatest risk reduction for perioperative stroke or death.CEA is recommended for asymptomatic patients with stenosis of 70% to 99% if the perioperative risk of stroke and death is 3,4 The number needed to treat (NNT) to prevent one stroke over two years is 9 for men and 36 for women. CEA is recommended as the first-line treatment for symptomatic low-risk surgical patients with a stenosis of 50% to 99% if the perioperative risk of stroke or mortality is ![]()
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