Risk factors of postprocedural hypotension following carotid artery stenting
1Department of Neurosurgery, Sapporo Medical University, School of Medicine, Chuo-ku, Sapporo; Hokkaido, Japan.
Insights
Postoperative hypotension after carotid stenting is common. Key risk factors include lesion proximity to the carotid bifurcation, eccentric stenosis, and calcifications, aiding in patient risk stratification.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Carotid stenting is a common procedure for preventing stroke.
- Postprocedural hypotension is a recognized complication.
- Identifying risk factors is crucial for patient management.
Purpose of the Study:
- To investigate risk factors for hypotension following elective carotid stenting.
- To correlate preoperative angiographic and ultrasonographic findings with hypotension.
- To identify patients at risk for prolonged postprocedural hypotension.
Main Methods:
- Retrospective analysis of 44 carotid stenting procedures in 40 patients.
- Correlation of hypotension (systolic < 90 mmHg for > 3 hours) with angiographic and ultrasonographic data.
- Statistical analysis of risk factors including lesion characteristics and calcifications.
Main Results:
- Postprocedural hypotension occurred in 47.5% of patients, requiring medical treatment in 27.5%.
- Significant risk factors identified: lesion distance from bifurcation (≤10 mm), eccentric stenosis, and carotid bifurcation calcifications.
- Age and degree of stenosis were not associated with hypotension.
Conclusions:
- Angiographic and ultrasonographic findings can identify patients at risk for postprocedural hypotension.
- Early identification allows for targeted pharmacological interventions.
- Proactive management can mitigate risks associated with hypotension post-carotid stenting.
Summary:
This study is performed to investigate risk factors of hypotension in response to elective carotid stenting. Forty-four lesions of 40 consecutive patients (mean age 70.4 +/- 8.2 years) were retrospectively analyzed. Easy Wall stent was applied in 15 lesions and SMART stent in 29 lesions. We investigated correlations between the occurrence rate of postoperative hypotension below 90 mmHg and persisting over three hours and findings of preoperative angiograms, ultrasonograms and clinical characteristics. Postprocedural hypotension occurred in 19 patients (47.5%) and medical treatment (intravenous administration of catecholamines) was required in eleven patients (27.5%). Although there was no permanent neurological deficits related with postprocedural hypotension, transient neurological deficits were found in three patients. Risk factors of prolonged postprocedural hypotension were statistically analyzed. On angiographic characteristics; 1) distance between the carotid bifurcation and the lesion with maximum stenosis ( 10 mm: p=0.031), 2) type of stenosis (eccentric vs. concentric: p=0.014) On ultrasonographic characteristics; 1) calcifications at the carotid bifurcation (present vs. absent: p < 0.001). Other variables, including age and degree of stenosis, were not associated with postprocedural hypotension after carotid stenting. These angiographic and ultrasonographic variables can be used to identify patients at risk for postprocedural hypotension after carotid stenting. Such identification may help in selection of patients who will benefit from appropriate pharmacological treatment.
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