Clevidipine versus nitroglycerin for blood pressure control during carotid endarterectomy: a cohort study

Background: Clevidipine is an ultrafast-acting dihydropyridine calcium channel antagonist with selective arteriolar-dilating effects that may be suitable for afterload reduction during surgeries requiring tight blood pressure control. The objective of this single-center retrospective observational study was to evaluate the role of clevidipine to control blood pressure during carotid endarterectomy. Methods: Patients undergoing elective carotid endarterectomy from October 2024 to March 2025 who received clevidipine or nitroglycerin for intraoperative blood pressure management were included. The primary endpoint was the area under the curve of systolic blood pressure excursions outside the predefined target range of 140–160 mmHg. Secondary outcomes included corresponding measurements for mean arterial pressure and heart rate, as well as the incidence of significant clinical complications. Results: Of 40 included patients, 20 received clevidipine and 20 received nitroglycerin. Patients in the clevidipine group spent significantly less time outside the goal systolic blood pressure range than the nitroglycerin group (10 min vs. 37.5 min, p < 0.001). The median normalized area under the curve per five-minute intervals was 29.59 mmHg × min (interquartile range, 15.83 to 49.35) in the clevidipine group versus 60.30 mmHg × min (interquartile range 42.79 to 74.38) in the nitroglycerin group (p = 0.005). There were no significant differences in mean arterial pressure, heart rate, or clinical complications between the groups. Conclusions: Clevidipine was associated with significantly fewer blood pressure excursions outside the target goal range compared to nitroglycerin during carotid endarterectomy.