Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting
Rishi Gupta1, Alex Abou-Chebl, Christopher T Bajzer
1Interventional Neurology, Section of Stroke and Neurological Critical Care, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Insights
Hemodynamic depression (HD) is common after carotid artery stenting (CAS), affecting 42% of patients. Persistent HD increases the risk of stroke and major adverse clinical events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- Hemodynamic depression (HD) is a known complication following carotid artery stenting (CAS) and carotid endarterectomy (CEA).
- Understanding the incidence, predictors, and outcomes of HD is crucial for patient safety during CAS procedures.
Purpose of the Study:
- To determine the frequency, predictors, and consequences of hemodynamic depression (HD) after carotid artery stenting (CAS).
Main Methods:
- Retrospective analysis of 500 consecutive CAS procedures over a 5-year period.
- HD defined as periprocedural hypotension or bradycardia.
- Logistic regression models used to identify predictors and consequences of HD.
Main Results:
- HD occurred in 42% of procedures; persistent HD in 17%.
- Predictors of HD included carotid bulb lesions and calcified plaque.
- Prior ipsilateral CEA reduced HD risk. Persistent HD was linked to increased risk of major adverse clinical events and stroke.
Conclusions:
- Hemodynamic depression is a frequent complication of CAS, especially with specific lesion characteristics.
- Persistent HD significantly elevates the risk of periprocedural major adverse clinical events and stroke.
- Prompt identification and management of HD are essential for improving patient outcomes after CAS.
Objectives:
We sought to determine the frequency, predictors, and consequences of hemodynamic depression (HD) after carotid artery stenting (CAS).
Background:
Hemodynamic depression has been reported after carotid artery stenting CAS and carotid endarterectomy (CEA).
Methods:
We retrospectively analyzed data on 500 consecutive CAS procedures performed over a 5-year period. Hemodynamic depression was defined as periprocedural hypotension (systolic blood pressure <90 mm Hg) or bradycardia (heart rate <60 beats/s). Univariate and multivariate binary logistic regression models were used to determine the predictors and consequences of HD and persistent HD.
Results:
The mean age of the patients was 70.5 +/- 10 years, and 69% were men. Hemodynamic depression occurred during 210 procedures (42%), whereas persistent HD developed in 84 procedures (17%). Features that independently predicted HD included lesions involving the carotid bulb (odds ratio [OR] 2.18 [range 1.46 to 3.26], p < 0.0001) or the presence of a calcified plaque (OR 1.89 [range 1.25 to 2.84], p < 0.002). Prior ipsilateral CEA was associated with reduced risk of HD (OR 0.35 [range 0.20 to 0.60], p < 0.0001). Patients who developed persistent HD were at a significantly increased risk of a periprocedural major adverse clinical event (OR 3.05 [range 1.35 to 5.23], p < 0.02) or stroke (OR 3.34 [range 1.13 to 9.90], p < 0.03).
Conclusions:
Hemodynamic depression is common after CAS, particularly in patients with a calcified plaque in the carotid bulb, but is easily treated with conventional methods. Patients who develop persistent HD are at an increased risk of periprocedural major adverse clinical events and stroke.
