Carotid artery stenting-induced hemodynamic instability
Spyridon N Mylonas1, Konstantinos G Moulakakis, Constantinos N Antonopoulos
1Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece. spyrosmylonas@gmail.com
Insights
Carotid artery stenting (CAS) can cause hemodynamic instability (HI) in a significant number of patients. However, this instability does not appear to increase perioperative risks like stroke or death.
Area of Science:
- Cardiovascular Interventions
- Neurosurgery
- Clinical Trials & Epidemiology
Background:
- Carotid artery stenting (CAS) is a common procedure for treating carotid artery stenosis.
- Hemodynamic instability (HI) is a potential complication during and after CAS.
- Understanding the incidence and impact of CAS-induced HI is crucial for patient safety.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of CAS-induced hemodynamic instability (HI).
- To explore differences in periprocedural risk between patients with and without CAS-associated HI.
Main Methods:
- Systematic review and meta-analysis of studies published between January 2000 and December 2011.
- Inclusion of 27 studies comprising 4204 patients undergoing CAS.
- Meta-regression analysis to identify factors associated with HI.
Main Results:
- The overall incidence of HI following CAS was 39.4%.
- Pooled estimates for hypotension and bradycardia were 12.1% and 12.2%, respectively.
- No significant differences in death, stroke, TIA, or major adverse events were observed between patients with and without HI.
Conclusions:
- CAS-induced HI is frequent but does not elevate perioperative risks.
- Prophylactic measures and close monitoring of hemodynamics are recommended for early management of HI.
Purpose:
To present a systematic review and meta-analysis investigating the incidence of carotid artery stenting (CAS)-induced hemodynamic instability (HI) and to explore differences in periprocedural risk among patients with and without CAS-associated HI.
Methods:
Multiple electronic health databases were searched for all articles published between January 2000 and December 2011 describing CAS-associated hemodynamic instability. Twenty-seven studies with a total of 4204 patients were analyzed, placing emphasis on the HI incidence and its correlation with postprocedure morbidity and mortality. A meta-regression analysis was conducted to investigate the role of potential meaningful modifiers upon HI.
Results:
The meta-analysis for overall HI rate showed a pooled proportion of 39.4%. The pooled estimate for hypotension was 12.1%, 12.2% for bradycardia, and 12.5% for both hypotension and bradycardia. Persistent HI was found to occur in a pooled rate of 19.2%. No statistically significant differences were found between patients with and without HI after CAS with respect to death, stroke, transient ischemic attack (TIA), or major adverse events. The meta-regression analysis revealed statistically significant associations of mean age with HI, of ≤10-mm distance between the carotid bifurcation and the site of minimum lumen diameter with bradycardia, and of prior ipsilateral CEA with persistent HI.
Conclusion:
CAS-induced HI occurs in a considerable percentage of patients without increasing the perioperative risk. However, applying the appropriate prophylactic measures and strictly monitoring blood pressure and heart rate during the procedure and immediately after should be encouraged for early recognition and correction of these hemodynamic disturbances.
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