Influence of stent type on hemodynamic depression after carotid artery stent placement
Nicolas Diehm1, Barry T Katzen, Florian Dick
1Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA.
Insights
Braided Elgiloy stents significantly reduced the risk of hypotension during carotid artery stenting compared to nitinol stents. This finding is crucial for optimizing patient safety in carotid artery interventions.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical device technology
Background:
- Carotid artery stenting (CAS) is a common procedure to prevent stroke.
- Hypotension and bradycardia are potential complications following CAS.
- Stent design may influence procedural hemodynamic stability.
Purpose of the Study:
- To compare the incidence of hypotension and bradycardia between nitinol and braided Elgiloy stents during CAS.
- To identify stent types associated with a higher risk of hemodynamic depression.
Main Methods:
- Retrospective analysis of 256 patients undergoing CAS between 1996 and 2007.
- Comparison of procedural and 24-hour hypotension and bradycardia rates between nitinol (n=212) and braided Elgiloy (n=44) stents.
- Logistic regression models used to adjust for confounding factors.
Main Results:
- Procedural hemodynamic depression occurred in 28.5% of patients.
- Nitinol stents were associated with a 11.3% rate of procedural hypotension, versus 0% for braided Elgiloy stents (P=.0188).
- Braided Elgiloy stents showed a significantly decreased rate of procedural hypotension (OR=0.165, P=.017) after multivariable adjustment.
Conclusions:
- Nitinol stents are linked to a higher risk of hypotension during CAS compared to braided Elgiloy stents.
- The choice of stent design may impact procedural hemodynamic complications.
- Further research into stent-specific risks is warranted for improved patient outcomes.
Purpose:
To assess the effect of stent type on hypotension and bradycardia after carotid artery stent placement.
Materials And Methods:
A retrospective analysis on a prospectively maintained database was conducted in 256 patients (126 men; mean age, 71.8 years +/- 8.6; 194 de novo lesions) undergoing carotid artery stent placement between January 1996 and January 2007 by using self-expanding stents. Braided Elgiloy stents (Wallstents) were used in 44 of the 256 patients (17.2%) and slotted-tube nitinol stents were deployed in 212 (82.8%). Bivariate and multivariable logistic regression models were used to determine the influence of stent design on procedural and 24-hour hypotension and bradycardia.
Results:
Procedural hemodynamic depression (HD) was encountered in 73 of the 256 patients (28.5%) due to hypotension in 24 (9.4%), bradycardia in 12 (4.7%), or both in 37 (14.5%) patients. Rates of procedural hypotension were 11.3% with nitinol stents and 0% with braided Elgiloy stents (P = .0188). Persistent postprocedural HD occurred in 91 of the 256 patients (35.5%) due to hypotension in 40 patients (15.6%), bradycardia in 23 (9.0%), or both in 28 (10.9%). Within a multivariable analysis adjusted for clinically relevant factors affecting rates of HD, the use of braided Elgiloy stents was associated with a decreased rate of procedural hypotension (odds ratio: 0.165; 95% confidence interval: 0.038, 0.721; P = .017). Procedural hypotension and bradycardia were not correlated to incidence of major adverse events but were associated with an increased duration of hospital stay (P = .0059 and P = .0335, respectively).
Conclusions:
Nitinol stents are associated with a higher risk of hypotension as compared to braided Elgiloy stents during carotid artery stent placement.
