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Prevention of hemodynamic instability in extra-cranial carotid angioplasty and stenting using temporary transvenous
Juan Liu1, Guo-en Yao, Hua-dong Zhou
1Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China.
Insights
Prophylactic temporary cardiac pacing effectively prevents hemodynamic instability during extra-cranial carotid angioplasty and stenting (CAS). This safe and rapid intervention is recommended for high-risk patients undergoing CAS procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Neurology
- Medical Device Technology
Background:
- Hemodynamic instability frequently complicates extra-cranial carotid angioplasty and stenting (CAS).
- Managing peri-procedural blood pressure and heart rate fluctuations is critical for patient safety during CAS.
Purpose of the Study:
- To evaluate the safety and efficacy of prophylactic temporary cardiac pacemaker placement during extra-cranial CAS.
- To assess the role of temporary cardiac pacing in preventing hemodynamic instability and related complications.
Main Methods:
- Forty-seven carotid artery stents were deployed in 41 high-risk patients undergoing CAS.
- Temporary transvenous cardiac pacemakers were inserted prior to CAS and set to a heart rate below 60 bpm.
- Clinical symptoms, blood pressure, heart rate, and pacemaker activation were continuously monitored.
Main Results:
- Pacemaker activation occurred in 25 patients during balloon predilatation, with transient use.
- One patient experienced post-procedural hypotension lasting 4 days; no other complications were observed.
- Pacing demonstrated technical efficacy in achieving ventricular responses and hemodynamic stability during CAS procedures.
Conclusions:
- Prophylactic temporary cardiac pacing is a safe, rapid, and effective method for controlling peri-operative hemodynamic instability during CAS.
- This approach can prevent stroke and other complications, particularly in high-risk individuals.
- Temporary transvenous cardiac pacing is strongly recommended for patients susceptible to hemodynamic compromise during CAS.
Abstract:
Hemodynamic instability is a common condition during extra-cranial carotid angioplasty and stenting (CAS). We evaluated the safety and efficacy of prophylactic placement of temporary cardiac pacemaker during extra-cranial CAS for the prevention of hemodynamic instability. For this, forty-seven carotid artery stents were deployed in 41 high-risk patients. Temporary transvenous cardiac pacemakers were inserted before CAS procedure. The pacers were set to capture a heart rate <60 bpm. Clinical symptoms, blood pressure, heart rate, and pacing activation were monitored and data were collected. We found that pacing occurred in 25 carotid lesions during balloon predilatation; pacemakers were activated transiently in 25 patients. The longest pacing continued for 1 day. Among cases with pacemaker activation, 1 patient developed post-procedural symptomatic hypotension that lasted for 4 days. No related complications were observed. It was, therefore, concluded that pacing was technically effective in producing electrical ventricular responses and was hemodynamically effective in 25 carotid lesions which underwent balloon predilatation. The prophylactic use of a temporary transvenous cardiac pacemaker during CAS was rapid and effective in controlling peri-operative hemodynamic instability and preventing stroke and other complications. The prophylactic use of temporary pacemaker is particularly recommended for patients at high risk for developing hemodynamic instability.
