Hemodynamic instability following carotid artery stenting
Javad Kojuri1, Mohammad Ali Ostovan, Nima Zamiri
1Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran. kojurij@yahoo.com
Neurosurgical Focus
|June 3, 2011
Summary
Hemodynamic instability (HI) frequently occurs after carotid artery stenting (CAS) but is generally benign. Autonomic dysfunction and degree of stenosis can predict HI post-CAS.
Area of Science:
- Cardiovascular medicine
- Neurology
- Interventional cardiology
Background:
- Postprocedural hypotension and bradycardia, termed hemodynamic instability (HI), are known complications of carotid artery stenting (CAS).
- The actual incidence and prognostic impact of HI following CAS remain subjects of debate in clinical practice.
Purpose of the Study:
- To investigate the incidence and short-term prognostic significance of hemodynamic instability (HI) after carotid artery stenting (CAS).
- To identify potential predictors of HI, including autonomic function, in patients undergoing CAS.
Main Methods:
- Twenty-seven patients undergoing CAS were monitored for hemodynamic instability (defined as systolic BP < 90 mm Hg or heart rate < 60 bpm).
- Continuous electrocardiography and blood pressure monitoring were performed, along with Valsalva maneuver testing to assess Valsalva ratios (VRs).
- Demographic data, degree of stenosis, and procedural details were compared between patients with and without HI.
Main Results:
- Hemi-dynamic instability (HI) developed in 63% of patients post-CAS.
- A higher degree of carotid artery stenosis significantly correlated with HI occurrence (p < 0.006).
- Lower Valsalva ratios (VRs) in the HI group indicated significant autonomic dysfunction (p < 0.003).
Conclusions:
- Hemodynamic instability (HI) is frequent after carotid artery stenting (CAS) but appears to be a benign complication with no short-term increase in mortality or morbidity.
- A resting Valsalva ratio (VR) below 1.10, baseline autonomic dysfunction, and the degree of carotid artery stenosis are predictive measures for HI after CAS.
Related Concept Videos
01:26Transient Ischemic Attack l: Introduction
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:15Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
01:26Cardiac Catheterization IV: Nursing Management
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...