Key result
Clevidipine linked to ~50% fewer SBP excursions outside target range post-surgery versus labetalol or urapidil.
Why the study?
Strict postoperative BP control within a narrow range is crucial after CEA to minimize stroke and hyperperfusion syndrome, but the comparative efficacy of clevidipine versus standard intravenous antihypertensive therapy was unclear.
Does intravenous clevidipine improve adherence to target systolic blood pressure ranges in adults undergoing carotid endarterectomy compared to standard therapy?
Cohort (n=97)
No
Does intravenous clevidipine improve adherence to target systolic blood pressure ranges in adults undergoing carotid endarterectomy compared to standard therapy?
In patients undergoing carotid endarterectomy, clevidipine provided superior adherence to strict postoperative systolic blood pressure targets compared to standard labetalol or urapidil therapy, without increasing adverse events.
Supports clevidipine for post-CEA BP target adherence; hypothesis-generating pending dedicated RCTs.
Strict postoperative blood pressure (BP) control within a narrow range is crucial after Carotid Endarterectomy (CEA) to minimize risks like stroke and hyperperfusion syndrome. Our institution targets a systolic BP (sBP) of 130–145 mmHg post-CEA. This study aimed to compare the efficacy of clevidipine versus standard intravenous antihypertensive treatment (labetalol ± urapidil) in maintaining this target range. This single-center, prospective cohort study included consecutive patients (> 18 years) undergoing CEA at Hospital Universitari de Girona Dr J Trueta, Girona, Spain, between August 2018 and October 2021. Patients received either clevidipine or non-clevidipine treatment (labetalol ± urapidil) based on physician preference. The primary outcome was the Area Under the Curve for sBP outside the target range (AUC-sBP), normalized per hour (mmHg x min/h), during the first six postoperative hours. Data were analyzed using non-parametric tests and adjusted linear regression. Data from 97 patients (44 clevidipine, 53 non-clevidipine [38 labetalol only, 15 labetalol + urapidil]) were analyzed. The clevidipine group had higher baseline sBP (144 ± 15 vs 140 ± 7 mmHg, SMD -0.34) and more comorbidities. Clevidipine use was associated with a significantly lower AUC-sBP compared to the non-clevidipine group (median [IQR]: 120 [92–150] vs 240 [240–300] mmHg x min/h, p < 0.00001). This association remained significant after adjusting for age, sex, and preoperative sBP (coef. -220 mmHg x min/h [95% CI -293 to -146], p = 0.0001). Mean cumulative clevidipine dose was 58 ± 86 mg over 14 ± 10 h. No significant differences were observed in secondary outcomes or pre-specified adverse events between groups. In this cohort, clevidipine treatment was associated with significantly better adherence to the target sBP range during the first six hours post-CEA compared to standard therapy with labetalol ± urapidil, without an observed increase in adverse effects.
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M et al. (2026) conducted a cohort in Carotid Endarterectomy (n=97). Clevidipine vs. Labetalol +/- urapidil was evaluated on Area Under the Curve for systolic Blood Pressure (AUC-sBP) excursions outside the target range (130-145 mmHg) per hour (Adjusted coefficient -220, 95% CI -293 to -146, p=0.0001). Clevidipine significantly reduced systolic blood pressure excursions outside the target range by an adjusted 220 mmHg x min/h compared to labetalol/urapidil in the first six hours post-surgery.
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