Factors associated with hemodynamic instability following carotid artery stenting
Jongwook Choi1, Ji Yong Lee2, Kum Whang1
1Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea.
Insights
Carotid artery stenting (CAS) can cause hemodynamic instability. Lesions near the carotid bulb increase risks, while pre-procedure antihypertensives may protect against hypotension.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Carotid artery stenting (CAS) is a key treatment for carotid artery stenosis, an alternative to carotid endarterectomy (CEA).
- Hemodynamic instability during and after CAS is common and linked to complications.
- Identifying risk factors for CAS-related hemodynamic instability is crucial for patient safety.
Purpose of the Study:
- To identify risk factors for hemodynamic instability following carotid artery stenting.
- To investigate the incidences of bradycardia and hypotension during and after CAS.
- To determine the association between lesion location and pre-procedure antihypertensive use with hemodynamic instability.
Main Methods:
- Retrospective analysis of 128 patients undergoing CAS between 2014 and 2019.
- Evaluation of medical records to identify risk factors for hemodynamic instability.
- Assessment of periprocedural and postprocedural bradycardia and hypotension.
Main Results:
- 14.1% of patients experienced bradycardia, and 11.7% had persistent hypotension.
- Carotid bulb involvement was an independent risk factor for both bradycardia and hypotension.
- Preoperative use of ≥2 antihypertensives protected against postprocedural hypotension but not bradycardia.
Conclusions:
- Carotid stenotic lesions involving the carotid bulb increase the risk of hemodynamic instability.
- Pre-procedure antihypertensive medication offers protection against post-CAS hypotension.
- Careful patient evaluation is necessary, especially for lesions near the carotid bulb.
Objective:
Carotid artery stenting (CAS) is a major treatment option for carotid artery stenosis, and a recognized alternative to carotid endarterectomy (CEA). However, CAS-related hemodynamic instability occurs frequently and is a known major risk factor of associated complications. This study was undertaken to identify the risk factors of hemodynamic instability associated with CAS.
Methods:
We analyzed the medical records of 128 patients with carotid artery stenosis treated by CAS at our institution from 2014 to 2019 to identify the risk factors of hemodynamic instability after CAS. In addition, the incidences of hemodynamic instability, including bradycardia and hypotension, during and after the procedure were investigated.
Results:
Overall, periprocedural bradycardia requiring atropine occurred in 18 (14.1 %) of the 128 study subjects, and postprocedural persistent hypotension requiring vasopressors occurred in 15 (11.7 %). Risk-adjusted analysis showed carotid bulb involvement of a stenotic lesion was an independent risk factor of periprocedural bradycardia (OR 4.25, 95 % CI 1.34-13.40) and postprocedural persistent hypotension (OR 7.36, 95 % CI 1.86-29.12). However, though a preoperative regimen of ≥ 2 antihypertensives was found to be an independent protective factor against postprocedural persistent hypotension (OR 0.17, 95 % CI 0.04-0.81), it was not associated with periprocedural bradycardia (OR 0.37 95 % CI 0.08-1.60).
Conclusions:
The risk of hemodynamic instability development is greater when a carotid stenotic lesion involves the carotid bulb, which cautions that careful evaluation is necessary. In addition, the receipt of antihypertensive regimens before CAS had a protective effect on persistent hypotension after CAS, but did not affect bradycardia.
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