Is haemodynamic depression during carotid stenting a predictor of peri-procedural complications?
E Cieri1, P De Rango, M R Maccaroni
1Division of Vascular and Endovascular Surgery, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
Insights
Haemodynamic depression (HD) during carotid stenting (CAS) is common (44%) but generally benign. Calcified plaque and longer lesion length predict HD, necessitating careful management, especially for severe calcified lesions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- The clinical significance of Haemodynamic Depression (HD) during carotid stenting (CAS) is not well understood.
- HD is defined as systolic blood pressure <90mmHg and/or heart rate <50 beats/min.
Purpose of the Study:
- To determine the frequency and predictors of HD during CAS.
- To analyze the clinical outcomes associated with HD in CAS patients.
Main Methods:
- Prospective study of 223 patients undergoing CAS over 15 months, excluding specific patient groups.
- Standardized atropine administration before stent deployment; monitoring of hemodynamic and neurological status.
- Multivariate analysis of 15 potential HD predictors, including plaque characteristics and stent parameters.
Main Results:
- HD occurred in 44% of patients, requiring pharmacological support in 68% of these cases.
- Stroke, TIA, and myocardial infarction rates were 3.1%, 1.8%, and 0.4%, respectively, with no significant difference between patients with or without HD.
- Calcified plaque (HR 9.5) and plaque length (HR 1.77) were significant predictors of HD.
Conclusions:
- HD during CAS is a frequent but typically benign event with no increased risk of peri-operative complications.
- Pharmacological management is crucial to mitigate HD, particularly in patients with calcified lesions.
- Further validation in larger cohorts is recommended.
Objective:
The clinical significance of Haemodynamic Depression (HD) during carotid stenting (CAS) remains unclear. The aim of this study was to analyze the frequency and predictors of HD during CAS in a single centre experience.
Methods:
A prospective protocol for CAS was applied in a 15-month interval. Patients with restenosis, on betablockers, or with arrhythmias were excluded. A standardized dose of atropine (0.4mg) was given prior to stent deployment. Changes in heart rate, blood pressure, and neurological status were monitored and recorded. HD was defined as systolic pressure <90mmHg and/or heart rate <50 beats/min. Fifteen potential predictors of HD (age, gender, hypertension, smoking, diabetes, coronary artery disease, previous myocardial infarction, symptoms, degree of carotid stenosis contralateral CEA or CAS, calcified/hyperechoic plaque, plaque length, stent oversizing and type of stent) were tested in multivariate analysis.
Results:
Two hundred and twenty three consecutive patients were enrolled. HD occurred in 98 cases (44%): in 68 cases HD required additional pharmacological support. At 30 days, any stroke rate was 3.1% (3 major and 4 minor), TIA rate 1.8%, myocardial infarction rate 0.4%. No deaths were recorded. No difference in complication rates were found in patients with or without HD. From regression analysis only the presence of calcified plaque (HR 9.5; 95% CI 5.0 to 18.2; p<0.0001) and the plaque length (HR 1.77; 95% CI 1.03 to 3.06; p=0.038) were associated significantly with HD.
Conclusions:
HD during CAS is a common, relatively benign event, without increased risk of peri-operative complications. Careful pharmacological treatment is necessary to decrease HD and the potential complications, especially in patients with more severe calcified lesions. These results require confirmation in a separate, larger cohort.
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