Prolonged hypotension following elective stenting of an internal carotid artery stenosis

Area of Science:

• Cardiovascular Medicine
• Neurology
• Interventional Cardiology

Background:

• Carotid artery stenosis poses a significant risk for stroke.
• Stenting is an alternative to endarterectomy for carotid stenosis.
• Maximal medical therapy is standard for asymptomatic stenosis progression.

Observation:

• A 72-year-old male underwent elective stenting for asymptomatic high-grade proximal left internal carotid artery stenosis.
• The indication was stenosis progression over 3 years despite maximal medical therapy and patient preference.
• The patient developed profound hypotension immediately post-stenting, requiring vasopressor support for a week.

Findings:

• The primary finding is profound, prolonged hypotension following carotid artery stenting.
• The proposed etiology is baroreceptor hyperactivity.
• This hyperactivity is hypothesized to be triggered by procedure-induced stretching of the carotid body.

Implications:

• This case suggests a potential, albeit rare, complication of carotid stenting.
• It underscores the importance of monitoring hemodynamic stability after carotid interventions.
• Further investigation into baroreceptor responses during carotid stenting may be warranted.