Complications and Predictors of Hypotension Requiring Vasopressor after Carotid Artery Stenting
Masataka Nanto1, Yudai Goto, Hiroyuki Yamamoto
1Department of Neurosurgery, Kyoto Second Red Cross Hospital.
Insights
Hypotension after carotid artery stenting (CAS) did not increase major adverse events. Hypertension was protective, while proximal protection and lesion proximity were risk factors for post-CAS hypotension.
Area of Science:
- Cardiovascular Medicine
- Interventional Neurology
- Vascular Surgery
Background:
- Hemodynamic depression following carotid artery stenting (CAS) is controversial regarding its impact on major adverse events.
- Understanding the incidence, predictors, and clinical significance of post-CAS hypotension is crucial for patient management.
Purpose of the Study:
- To evaluate the incidence, predictors, and clinical significance of hypotension after carotid artery stenting.
- To determine if post-procedural hypotension is associated with increased major adverse events following CAS.
Main Methods:
- Retrospective analysis of 118 patients undergoing CAS for carotid artery stenosis.
- Hypotension defined as systolic blood pressure <80 mmHg requiring vasopressors post-procedure.
- Comparison of baseline, procedural characteristics, and periprocedural adverse events between hypotension and non-hypotension groups.
Main Results:
- No significant differences in morphological or procedural characteristics between groups.
- Periprocedural major adverse events, new ischemic lesions, and lesion counts were similar in both groups (P=1, P=0.36, P=0.68).
- Hypertension was protective (P=0.037); proximal protection (P=0.034) and lesion proximity ≤10 mm (P=0.027) were risk factors for hypotension.
Conclusions:
- Hypotension after CAS was not significantly associated with major adverse events in this cohort.
- Maintaining adequate cerebral perfusion during the periprocedural period is vital for preventing ischemic complications.
- Identifying risk factors like proximal protection and lesion proximity can aid in managing post-CAS hypotension.
Abstract:
A significant controversy exists regarding the clinical impact of hemodynamic depression on major adverse events after carotid artery stenting (CAS). The purpose of this study was to evaluate the incidence, predictors, and clinical significance of hypotension after CAS. A total of 118 cases of carotid artery stenosis were treated with CAS. Hypotension was defined as sustained systolic blood pressure <80 mmHg and requiring intravenous administration of vasopressor to maintain adequate systolic blood pressure after the procedure. Baseline characteristics, procedural characteristics, and periprocedural major adverse events were retrospectively compared between postprocedural hypotension group and non-hypotension group. Morphological and procedural characteristics were not significantly different between the two groups. Periprocedural major adverse events, presence of new ischemic lesions, and number of new ischemic lesions were not significantly different between the two groups (P = 1, P = 0.36, P = 0.68). Hypertension was an independent protective factor (P = 0.037), and use of proximal protection and the distance from carotid bifurcation to maximum stenotic lesion ≤ 10 mm were independent risk factors for developing hypotension after CAS (P = 0.034, P = 0.027). There was no significant relationship between hypotension after CAS and major adverse events in this study. Maintenance of periprocedural adequate cerebral perfusion is thought to be important to prevent ischemic complications due to hypotension after CAS, especially in these cases.
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