Prediction of Prolonged Hemodynamic Instability During Carotid Angioplasty and Stenting
Jong Kook Rhim1, Jin Pyeong Jeon2, Jeong Jin Park3
1Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea.
Insights
Carotid angioplasty and stenting (CAS) can lead to prolonged hemodynamic instability (HDI). Calcification, eccentric stenosis, and plaque distribution are key risk factors identified in this study.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Cardiovascular Research
Background:
- Carotid angioplasty and stenting (CAS) is a common procedure for treating carotid artery stenosis.
- Hemodynamic instability (HDI) is a potential complication following CAS, necessitating risk factor identification.
- Predictive tools for prolonged HDI after CAS are crucial for patient management and procedural safety.
Purpose of the Study:
- To identify risk factors associated with prolonged hemodynamic instability (HDI) after carotid angioplasty and stenting (CAS).
- To propose and validate a simplified predictive scoring system for prolonged HDI in patients undergoing CAS.
Main Methods:
- Retrospective analysis of 66 patients who underwent CAS between 2011 and 2016.
- Definition of prolonged HDI: systolic blood pressure >160 or <90 mm Hg, or heart rate <50 bpm for >30 minutes despite treatment.
- Evaluation of clinical data and radiologic findings, including plaque morphology and stenosis characteristics.
Main Results:
- Prolonged HDI occurred in 31.8% of patients.
- Multivariable analysis identified calcification (OR 6.726), eccentric stenosis (OR 3.645), and extensive plaque distribution (OR 7.169) as significant predictors of prolonged HDI.
- A scoring system based on these factors showed increasing HDI risk with higher scores (8.7% to 100%).
Conclusions:
- Calcification, eccentric stenosis, and extensive plaque distribution are significant risk factors for prolonged HDI post-CAS.
- A simplified scoring system effectively predicts the risk of prolonged hemodynamic instability after carotid angioplasty and stenting.
Purpose:
The aim of this study was to assess the risk factors of prolonged hemodynamic instability (HDI) after carotid angioplasty and stenting (CAS). Herein, a simplified predictive scoring system for prolonged HDI is proposed.
Materials And Methods:
Sixty-six patients who had CAS from 2011 to 2016 at a single institution were evaluated. Prolonged HDI was defined as systolic blood pressure >160 mm Hg or <90 mm Hg or heart rate <50 beats/min, lasting over 30 minutes despite medical treatments. For the study, clinical data and radiologic data, including plaque morphology and stenosis were analyzed.
Results:
Prolonged HDI was observed in 21 patients (31.8%). Multivariable analysis revealed that calcification (OR, 6.726; p=0.006), eccentric stenosis (OR, 3.645; p=0.047) and extensive plaque distribution (OR, 7.169; p=0.006) were related to prolonged HDI. According to these results, a simplified scoring scale was proposed based on the summation of points: 2 points for calcified plaque, 2 points for extensive plaque distribution, and 1 point for eccentric stenosis. The percentages of prolonged HDI according to the total score were as follows: score 0, 8.7%; score 1, 20.0%; score 2, 38.5%; score 3, 72.7%; score 4, 66.7%; score 5, 100%. From the analysis, the total score in patients with prolonged HDI was significantly higher than those without prolonged HDI (p<0.001).
Conclusion:
Prolonged HDI can be associated with calcification of plaque, eccentric stenosis and extensive plaque distribution, and a simplified scoring system enables prediction of prolonged HDI according to our cohort.
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