Overlapped Stenting Is Associated with Postoperative Hypotension after Carotid Artery Stenting
Daizo Ishii1, Shigeyuki Sakamoto1, Takahito Okazaki1
1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Insights
Overlapped stenting and intraoperative hypotension are key predictors of postoperative hypotension after carotid artery stenting (CAS). Strict blood pressure control is crucial for patients undergoing CAS, especially those with overlapped stenting or intraoperative hypotension.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Post-procedural hypotension (HT) is a common complication following carotid artery stenting (CAS), potentially leading to adverse outcomes like stroke or myocardial infarction.
- This study investigated risk factors for HT after CAS, hypothesizing that overlapped stenting techniques may contribute to its occurrence.
Observation:
- A review of 106 lesions in 95 patients undergoing CAS identified postoperative HT in 30 (28.3%) cases.
- Patients experiencing postoperative HT showed a higher incidence of overlapped stenting, use of open-cell stents, and intraoperative HT compared to those without HT.
Findings:
- Multivariate analysis identified overlapped stenting and intraoperative HT as independent predictors of postoperative hypotension after CAS.
- Shorter distances from the carotid bifurcation and maximum stenotic lesion length were also noted as potential, though not statistically significant, factors in patients with postoperative HT.
Implications:
- Overlapped stenting is a significant factor influencing postoperative hypotension after CAS.
- Close monitoring and strict blood pressure management are recommended for patients undergoing CAS, particularly those with overlapped stenting or intraoperative hypotension to mitigate risks.
Background:
Hypotension (HT) is well recognized to frequently occur during and after carotid artery stenting (CAS), which sometimes causes postoperative complications such as stroke or myocardial infarction. This study aimed to examine the risk factors associated with HT after CAS based on the hypothesis that overlapped stenting may affect postoperative HT.
Methods:
A total of 106 lesions in 95 patients with carotid artery stenosis who underwent CAS were reviewed. Bradycardia and HT were defined as a heart rate and a systolic blood pressure less than 60 beats/min and 100 mm Hg, respectively. The patients were categorized by the presence (group H) or the absence (group N) of postoperative HT, respectively, and demographic data, risk factors, conditions of carotid artery stenosis, procedures, and pre- and intraoperative hemodynamics were compared between these 2 groups. Multivariate analysis was performed to evaluate independent factors associated with postoperative HT.
Results:
In total, postoperative HT was observed in 30 (28.3%) cases. The incidence of overlapped stenting, the use of an open-cell stent, and intraoperative HT were significantly higher in group H (P = .03, .01 and < .01, respectively). The distance from carotid bifurcation and the maximum stenotic lesion tended to be shorter in group H (P = .09). In the multivariate logistic regression analysis, using all these variables, the overlapped stenting and intraoperative HT were found to be independent predictors for postoperative HT.
Conclusion:
The overlapped stenting affected postoperative HT after CAS. Blood pressure should be strictly controlled in cases with overlapped stenting or intraoperative HT after CAS.
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