The Prevalence and Factors Contributing to Hemodynamic Depression in Patients Undergoing Carotid Angioplasty and
Afshin Borhani Haghighi1, Safoora Kokabi2, Samaneh Yousefi3
1Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Hemodynamic depression after carotid angioplasty and stenting is common. Preprocedure blood pressure and open cell stent design were associated with this complication, while hydration and close-cell stents may reduce risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Hemodynamic depression, characterized by bradycardia and hypotension, frequently complicates carotid angioplasty and stenting (CAS).
- Understanding the risk factors and preventative strategies for hemodynamic depression is crucial for patient safety during CAS procedures.
Purpose of the Study:
- To investigate the incidence and associated factors of postprocedural hemodynamic depression in patients undergoing CAS.
- To identify potential interventions for mitigating the risk of hemodynamic depression following CAS.
Main Methods:
- A prospective, cross-sectional study included consecutive patients undergoing CAS.
- Data collected included demographics, risk factors, blood pressure, stenosis details, and procedural factors.
- Hemodynamic depression was defined as systolic blood pressure <90 mmHg and/or heart rate <50 bpm.
Main Results:
- Of 170 patients, 7.6% developed bradycardia, 24% hypotension, and 7% both.
- Hemodynamic depression was significantly associated with preprocedural blood pressure and the use of open cell stent designs.
- No significant association was found with atherosclerotic risk factors, stenosis characteristics, or dilation techniques. Hemodynamic depression correlated with increased hospital stay.
Conclusions:
- Preprocedural hydration and the use of close-cell stents may reduce the incidence of post-CAS hemodynamic depression.
- Close monitoring of blood pressure and heart rate is essential during and after CAS.
Background:
Hemodynamic depression, including bradycardia and hypotension, is among the most common complications of carotid angioplasty and stenting.
Methods And Material:
A prospective, cross-sectional study was conducted at Shiraz University of Medical Sciences in southern Iran from 2011 to 2013. Consecutive patients undergoing carotid angioplasty and stenting were included. Demographic data, atherosclerotic risk factors, preprocedural blood pressure, the site of stenosis, the degree of stenosis, and data regarding technical factors were recorded. Hemodynamic depression was defined as a systolic blood pressure less than 90 mmHg and/or heart rate less than 50 beat/min.
Results:
About 170 patients (67% male, mean age: 71+9.8, 55.9% right side, 82.9% symptomatic) were recruited. Mean degree of stenosis was 79.4% in operated side and 40.7% in nonoperated side. Predilation, postdilation, or both were conducted in 18(10.5%), 141(83%), 11(6.5%) patients respectively. Thirteen (7.6%), 41(24%), and 12(7%) of patients developed postprocedural bradycardia, hypotension or both, respectively. Two patients had a stroke after CAS and periprocedural mortality was 0%. Hemodynamic depression after CAS had a significant association with preprocedure blood pressure and the use of an open cell stent design, but not with atherosclerotic risk factors, site and/or degree of stenosis, predilation, or postdilation. Hemodynamic depression significantly increased hospital stay too.
Conclusion:
Preprocedural hydration and close-cell stents may decrease the risk of poststenting hemodynamic depression.
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