Prediction of prolonged postprocedural hypotension after carotid artery stenting
Tadashi Nonaka1, Shinichi Oka, Kei Miyata
1Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan. tnonaka@sapmed.ac.jp
Insights
Predictors of prolonged hypotension after carotid stenting were identified using imaging. A new scoring system based on angiographic and ultrasonographic findings can help predict patients at high risk for this complication.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenting (CAS) can lead to hemodynamic instability and ischemic complications, particularly in patients with bilateral carotid lesions.
- Identifying predictors of post-procedural hypotension is crucial for patient management.
Purpose of the Study:
- To define predictors of persistent hypotension following carotid stenting.
- To develop a scoring system for predicting prolonged hypotension after CAS.
Main Methods:
- Retrospective analysis of 33 lesions in 31 patients undergoing CAS.
- Review of preoperative angiograms and ultrasonograms.
- Analysis of factors predicting prolonged hypotension (systolic blood pressure < 90 mm Hg for > 3 hours).
Main Results:
- Post-procedural hypotension occurred in 42.4% of lesions.
- Independent risk factors identified: lesion distance from bifurcation (≤10 mm), eccentric stenosis, echogenic plaque morphology, and carotid bifurcation calcification.
- A scoring system incorporating these factors was developed; a score of 3 or more indicated high risk.
Conclusions:
- A novel scoring system integrating angiographic and ultrasonographic findings can predict prolonged hypotension after carotid stenting.
- This predictive tool may aid in reducing periprocedural ischemic events.
Objective:
Stent placement for the treatment of carotid artery stenosis may cause hemodynamic instability that induces ischemic complications for patients with bilateral carotid lesions. We carried out this study to define predictors of persistent hypotension after carotid stenting.
Methods:
Thirty-three lesions in 31 consecutive patients (mean age, 69.2 +/- 8.6 yr) who underwent stent deployment for carotid stenosis were studied. Fourteen lesions were treated with Easy Wall stents (Boston Scientific, Tokyo, Japan) and 19 lesions were treated with Smart stents (Johnson & Johnson, Warren, NJ). We reviewed preoperative angiograms and ultrasonograms of the carotid artery and analyzed the predictive factors of postprocedural prolonged hypotension (systolic blood pressure < 90 mm Hg and periods > 3 h).
Results:
Postprocedural hypotension was observed in 14 lesions (42.4%), of which medical treatment was necessary in seven (21.2%). A distance between carotid bifurcation and maximum stenotic lesion (< or = 10 mm; P = 0.0028) and type of stenosis (eccentric; P = 0.0287) on angiogram and fibrous plaque morphological features (P = 0.0008) and calcifications at carotid bifurcation (P = 0.0004) on ultrasonograms were determined to be independent risk factors of postprocedural hypotension. We introduced a scoring system for predicting prolonged hypotension that included factors such as the distance from carotid bifurcation to maximum stenotic lesion (< or = 10 mm), type of stenosis (eccentric), plaque morphological features (echogenic), and calcification at carotid bifurcation. The score was determined by adding one point for each of these factors. Three points or more on this score strongly suggested a high risk of prolonged hypotension.
Conclusion:
Our scoring system, which includes angiographic and ultrasonographic findings, may be a good index for the prediction of prolonged hypotension after carotid stenting and may contribute to the reduction of periprocedural ischemic events.
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