BACKGROUND Carotid endarterectomy (CEA) is a standard treatment for carotid artery stenosis, but the incidence after periprocedural myocardial infarction (MI) is not negligible. The mechanism for the higher risk of MI following CEA compared with the carotid artery stenting (CAS) is unclear. We hypothesized that it may be explained by different autonomic nervous responses. METHODS This prospective, nonrandomized, observational study enrolled 50 patients from 2 centers: 25 underwent CEA and 25 CAS. Cardiac autonomic nervous activity was evaluated using 24-hour high-resolution ambulatory electrocardiography with parameters such as deceleration capacity (DC) and heart rate variability before the procedure, and at 1 week and 1-3 months after the procedure. RESULTS One week after CEA, decreased DC and increased acceleration capacity were recognized. Standard deviation of sequential 5-minute NN interval means and the low-frequency and high-frequency components were all decreased. By the later phase measurement, these changes returned to baseline or beyond. The results suggest that diminished autonomic activity reversed to excessive parasympathetic dominance. In contrast, the patients treated by CAS showed no remarkable autonomic modification in the early or later phases. CONCLUSIONS Distinct changes of sympathovagal response observed after CEA coincides with the time at which MI onset occurs, suggesting prolonged autonomic fluctuation may be a factor in the MI incidence after CEA.

中文翻译：

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颈动脉内膜切除术后副交感神经张力亢进引起的长时间自主神经波动，但不包括支架术。

背景技术颈动脉内膜切除术（CEA）是颈动脉狭窄的标准治疗方法，但围手术期心肌梗死（MI）的发生率不可忽略。与颈动脉支架置入术（CAS）相比，CEA后发生MI的更高风险的机制尚不清楚。我们假设这可能是由不同的植物神经反应引起的。方法这项前瞻性，非随机，观察性研究招募了来自2个中心的50位患者：25位接受了CEA和25位CAS。在手术前以及手术后1周和1-3个月，使用24小时高分辨率动态心电图对心脏的自主神经活动进行评估，其参数包括减速能力（DC）和心率变异性。结果CEA后1周，发现DC降低，加速能力增强。连续5分钟NN间隔均值的标准偏差以及低频和高频分量均减小。在以后的阶段测量中，这些更改返回到基线或更高。结果表明，自主神经活动减弱转为过度副交感神经支配。相比之下，CAS治疗的患者在早期或晚期均无明显的自主神经功能改变。结论CEA后观察到的交感迷走神经反应的明显变化与MI发作的发生时间相吻合，提示长时间的自主神经波动可能是CEA术后MI发生的一个因素。结果表明，自主神经活动减弱转为过度副交感神经支配。相比之下，CAS治疗的患者在早期或晚期均无明显的自主神经功能改变。结论CEA后观察到的交感迷走神经反应的明显变化与MI发作的发生时间相吻合，提示长时间的自主神经波动可能是CEA术后MI发生的一个因素。结果表明，自主神经活动减弱转为过度副交感神经支配。相比之下，CAS治疗的患者在早期或晚期均无明显的自主神经功能改变。结论CEA后观察到的交感迷走神经反应的明显变化与MI发作的发生时间相吻合，提示长时间的自主神经波动可能是CEA术后MI发生的一个因素。