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Postprocedural hypotension after carotid artery stent placement: predictors and short- and long-term clinical
G Dangas1, J R Laird, L F Satler
1Division of Cardiology and the Departments of Neuroradiology and Neurology, Washington Hospital Center, Washington, DC, USA.
Insights
Hypotension after carotid artery stenting (CAS) is common with balloon-expandable stents, leading to more in-hospital strokes and increased long-term mortality risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Neurology
- Vascular Surgery
Background:
- Carotid artery stenting (CAS) is a procedure to open blocked carotid arteries.
- Post-procedural hypotension can be a significant complication.
- Predictors and outcomes of this hemodynamic disturbance require further investigation.
Purpose of the Study:
- To identify predictors of persistent hypotension following CAS.
- To define the clinical outcomes for patients experiencing post-CAS hypotension.
Main Methods:
- A total of 140 CAS procedures were analyzed in 133 patients.
- Post-CAS hypotension was defined as a >40 mm Hg drop in blood pressure, systolic pressure <90 mm Hg, lasting at least 1 hour, without hypovolemia.
- Patients were divided into two groups: those with post-CAS hypotension (group 1, n=25) and those without (group 2, n=108).
Main Results:
- Hypotension occurred in 33.9% of cases with balloon-expandable stents versus 13.6% with self-expanding stents (P=.04).
- In-hospital minor strokes were higher in group 1 (16%) compared to group 2 (3%) (P=.03).
- Long-term total mortality at 10 months was significantly greater in group 1 (20%) than in group 2 (4%) (P=.02).
Conclusions:
- Hypotension post-CAS, often due to carotid sinus stimulation, is frequent with balloon-expandable stents.
- This hemodynamic complication is associated with increased in-hospital complications and a higher long-term mortality risk.
Purpose:
To describe the predictors of persistent hypotension after carotid artery stent (CAS) placement and define the clinical outcome of patients with this hemodynamic disturbance.
Materials And Methods:
One hundred forty CAS procedures were performed in 133 consecutive patients. Post-CAS hypotension-defined as a greater than 40 mm Hg decrease in arterial pressure without evidence of hypovolemia, with a systolic pressure lower than 90 mm Hg at the end of CAS and lasting at least 1 hour-was observed in 25 patients (group 1); 108 patients did not have hypotension (group 2).
Results:
Post-CAS hypotension developed in 33.9% of cases after balloon-expandable stent placement versus in 13.6% of cases after self-expanding stent placement (P =.04). In-hospital minor ipsilateral strokes occurred in 16% of cases in group 1 versus in 3% of cases in group 2 (P =.03). There was one (0.9%) major stroke (transient) and three (2.6%) transient ischemic attacks, all of which occurred in group 2 (not significant vs group 1 for both conditions). At 10 months +/- 4 (SD) of follow-up, there was greater total mortality in group 1 than in group 2 (20% vs 4%, P =.02), whereas neurologic events did not differ significantly between the groups.
Conclusion:
Hypotension due to carotid sinus stimulation is frequent after CAS with balloon-expandable stents. This phenomenon correlates with increased in-hospital complications and long-term risk of death.