Determinants and outcomes of asystole during carotid artery stenting
Kumar Satya1, Kathy Dougherty, Vei-Vei Lee
1Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
Insights
Asystole during carotid artery stenting (CAS) is linked to right-sided procedures, contralateral stenosis, and reduced left ventricular ejection fraction (LVEF). Increased caution is advised for right-sided CAS due to higher risks of stroke and mortality.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Carotid artery stenting (CAS) is a common procedure to prevent stroke.
- Asystole, a transient cardiac arrest, can occur during CAS, but its predictors and outcomes are not fully understood.
- Understanding these factors is crucial for improving patient safety during CAS.
Purpose of the Study:
- To identify predictors of asystole during CAS.
- To determine the outcomes associated with asystole following CAS.
- To inform procedural modifications for enhanced patient safety.
Main Methods:
- Retrospective review of 884 patients undergoing CAS between 1997 and 2009.
- Identification of 43 patients who experienced asystole during CAS.
- Comparison with a control group of 678 patients without asystole, using univariate and multivariate logistic analyses.
Main Results:
- Right-sided CAS procedures were significantly associated with asystole (OR 11.4).
- Contralateral carotid stenosis (OR 1.7) and reduced left ventricular ejection fraction (LVEF <40%) (OR 2.2) were also predictors of asystole.
- Smokers showed a reduced likelihood of asystole (OR 0.25).
- The asystole group experienced higher rates of periprocedural stroke (14% vs. 1.3%), longer hospital stays, and increased 30-day mortality (11.6% vs. 4.1%).
Conclusions:
- Asystole during CAS is more prevalent in procedures involving the right carotid sinus.
- Patients with contralateral carotid stenosis and reduced LVEF are at higher risk.
- Increased vigilance and procedural modifications are recommended for right-sided CAS procedures to mitigate risks.
Purpose:
To examine the predictors and outcomes of asystole in patients who undergo carotid artery stenting (CAS).
Methods:
Forty-three patients (24 men; median age 69 years) with asystole were identified after reviewing the case records of 884 patients who underwent CAS at our institution between 1997 and 2009. The control group comprised 678 patients who underwent stenting in the carotid sinus area without asystole. Univariate and multivariate logistic analyses were used to determine the predictors and outcomes of asystole.
Results:
A right-sided procedure was more likely to result in asystole [odds ratio (OR) 11.4, 95% CI 4.0 to 32.7, p<0.0001] compared with a left-sided procedure. Patients with a contralateral carotid stenosis (OR 1.7, 95% CI 1.0 to 2.8, p = 0.04) and a left ventricular ejection fraction (LVEF) of <40% (OR 2.2, 95% CI 1.1 to 4.5, p = 0.03) were also more likely to suffer asystole. Smokers appeared less likely to develop asystole (OR 0.25, 95% CI 0.12 to 0.56, p = 0.0006). Periprocedural stroke (14% vs. 1.3%, p<0.001), length of stay during index hospitalization (2.2 vs. 1.2 days, p = 0.002), and 30-day mortality (11.6% vs. 4.1%, p = 0.02) were significantly higher in the asystole group.
Conclusion:
Asystole during CAS is more likely to occur in patients undergoing procedures in the right carotid sinus area, in those who have significant contralateral carotid stenosis, and in those with a reduced LVEF. More caution should be exercised during right-sided than left-sided CAS procedures.
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