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Updated: Aug 10, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Hemodynamic instability after extracranial carotid stenting

G Pappadà1, E Beghi, R Marina

  • 1Department of Neurosurgery, University of Milano-Bicocca, Ospedale San Gerardo, Monza-Milan, Italy.

Acta Neurochirurgica
|March 9, 2006
PubMed

Insights

Carotid angioplasty with stenting (CAS) can cause hemodynamic instability, including hypertension and bradycardia. These complications, while occurring in some patients, could not be predicted by clinical or procedural factors in this study.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Neurology

Background:

  • Hemodynamic instability, including hypertension, hypotension, and bradycardia, is a known complication of carotid endarterectomy.
  • Carotid angioplasty and stenting (CAS) is an alternative treatment for severe carotid stenosis, particularly in high-risk surgical patients.
  • Instrumentation of the carotid bulb during CAS can lead to baroreceptor dysfunction and subsequent hemodynamic instability.

Purpose of the Study:

  • To determine the incidence of hemodynamic instability following CAS.
  • To identify clinical, procedural, and angiographic factors that predict these complications.

Main Methods:

  • Retrospective review of medical records and angiograms of 51 patients undergoing CAS for atherosclerotic stenosis or restenosis.
  • Monitoring for intra- and post-procedural hypertension, hypotension, and bradycardia.
  • Univariate and multivariate logistic regression analysis to assess predictors of hemodynamic instability.

Main Results:

  • Transient mild post-procedural hypertension occurred in 10% of patients, predicted by preprocedural hypertension, asymptomatic stenosis, and restenosis.
  • Hypotension with bradycardia occurred in 10% of patients, with one case resulting in neurological sequelae.
  • Transient periprocedural bradycardia occurred in 37% of patients; severe bradycardia without hypotension was rare.
  • Factors predicting post-procedural hypotension included fibrous plaque and internal carotid artery diameter ratio; peri-procedural bradycardia predicted post-procedural bradycardia.
  • Multivariate analysis did not confirm any significant prognostic predictors for these complications.

Conclusions:

  • Mild systolic hypertension post-CAS is generally manageable with medical treatment.
  • Prolonged hypotension and bradycardia can occur, posing a risk of neurological deterioration due to hypoperfusion.
  • Current clinical, procedural, and angiographic factors are insufficient for predicting hemodynamic instability after CAS.
Abstract

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