Prolonged hypotension following elective stenting of an internal carotid artery stenosis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Neurology

Background:

• Carotid artery stenosis poses a risk for stroke, managed medically or interventionally.
• Stenting is an option for carotid stenosis, particularly when endarterectomy is less suitable.
• Asymptomatic high-grade stenosis management remains debated, balancing intervention risks with stroke prevention.

Observation:

• A 72-year-old male underwent elective stenting for proximal left internal carotid artery stenosis.
• The stenosis progressed over 3 years despite maximal medical therapy.
• Patient preferred stenting over endarterectomy.

Findings:

• The patient developed profound hypotension immediately post-stenting.
• Prolonged vasopressor support was required for over a week.
• The hypothesized cause is baroreceptor hyperactivity due to procedure-induced carotid body stretching.

Implications:

• This case highlights a rare but serious complication of carotid stenting.
• It suggests the need to consider baroreceptor sensitivity in post-procedural monitoring.
• Further research may explore pre-procedural screening for baroreceptor dysfunction.