[Hemodynamic depression in carotid artery stent without angioplasty]
Luis Garciá-Nielsen1, José M Carreira, Martín Rabellino
1Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Espana.
Insights
Carotid artery stenting without angioplasty significantly reduces hemodynamic depression and neurological complications. This technique offers a safer alternative for treating carotid stenosis.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Context:
- Hemodynamic depression is a common complication of carotid artery stenting with angioplasty.
- Carotid artery stenting (CAS) is a procedure to open narrowed carotid arteries.
- Angioplasty balloons are often used during CAS, potentially causing hemodynamic instability.
Purpose:
- To evaluate the incidence of hemodynamic depression in patients undergoing carotid artery stenting without angioplasty.
- To assess the safety and efficacy of CAS performed without balloon angioplasty.
- To compare outcomes of CAS with and without angioplasty.
Summary:
- A study of 261 carotid stenosis treatments (242 patients) using self-expanding stents without angioplasty was conducted.
- Low rates of bradycardia (2.9%) and hypotension (1.2%) were observed during the procedure.
- Post-procedure, low incidences of TIA (4.5%), stroke (0.8% total), and death (0.4%) were reported, with no hemodynamic depression during hospitalization.
Impact:
- Carotid stenting without angioplasty demonstrates a low incidence of hemodynamic depression.
- This approach appears to reduce neurological complications compared to stenting with angioplasty.
- Further randomized trials are warranted to compare the two techniques directly.
Introduction:
Hemodynamic depression is a frequent complication related to carotid artery stenting with angioplasty. The aim of this study was to assess our results regarding hemodynamic depression, in patients who underwent carotid artery stenting without angioplasty.
Patients And Methods:
Between October 2002 and April 2010, 261 carotid stenosis (in 242 patients) were treated with the use of self-expanding stents without angioplasty. Inclusion criteria were symptomatic carotid stenosis > 50%, asymptomatic carotid stenosis > 70%, and stenosis ranging between 50-70% with evidence of high risk plaque morphology or micro-embolism. Outcomes during hospitalization and 30 days after procedure were registered. Hemodynamic depression was defined as hypotension (systolic blood pressure < 90 mm Hg) or bradycardia (heart rate < 60 beats/min).
Results:
During the procedure 7 (2.9%) patients presented bradycardia and 3 (1.2%) hypotension. No patient required vasopressor drugs or ICU for hemodynamic monitoring. No patient developed asystole or other types of arrhythmia. During hospitalization, hemodynamic depression was not observed in any patients. During the first 30 days post-procedure, there were 11 TIAs (4.5%), 1 disabling stroke (0.4%), 1 non disabling stroke (0.4%), and 1 death (0.4%) (1 stent thrombosis at 11 days).
Conclusion:
The incidence of hemodynamic depression is low when carotid stenting procedure is performed without balloon angioplasty. The incidence of neurological complications post procedure was also low. This report highlights the need for performing randomized trials comparing both techniques.
