Predictors of Carotid Artery Stenting-Induced Hemodynamic Instability
Mahmoud Saleh1, Haitham Ali1, Khaled Atalla1
1Vascular and Endovascular Surgery Department, 68866Assiut University Hospitals, Assiut, Egypt.
Insights
Hemodynamic instability (HI) affects over 30% of patients undergoing carotid artery stenting (CAS). Key risk factors include hypertension and lesion characteristics, while smoking appears protective, with no increased risk of adverse events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Carotid artery stenting (CAS) is a common procedure for atherosclerotic carotid artery stenosis.
- Hemodynamic instability (HI) is a potential complication during CAS.
- Understanding predictors of HI and its impact on outcomes is crucial.
Purpose of the Study:
- To identify predictors of periprocedural hemodynamic instability (HI) during carotid artery stenting (CAS).
- To evaluate the association between HI and periprocedural adverse outcomes following CAS.
Main Methods:
- Retrospective analysis of 728 consecutive patients undergoing CAS from March 2014 to May 2018.
- Standardized atropine administration prior to stent deployment.
- Multivariate logistic regression analysis to identify predictors of HI.
Main Results:
- Periprocedural HI occurred in 31.2% of patients.
- Predictors of HI included hypertension, symptomatic lesions, right-sided lesions, calcified plaques, and longer lesions.
- Smoking was associated with a reduced risk of HI (OR, 0.519).
Conclusions:
- HI is a frequent complication of CAS.
- Hypertension, lesion characteristics (symptomatic, right-sided, calcified, longer) are independent risk factors for HI.
- Smoking shows a protective effect, and HI does not increase periprocedural morbidity or mortality.
Background:
To address the predictors of hemodynamic instability (HI) related to carotid artery stenting (CAS) and evaluate the association between HI and periprocedural adverse outcomes.
Methods:
This study comprised all consecutive patients who underwent CAS for atherosclerotic carotid artery stenosis from March 2014 to May 2018. A standardized dose of atropine (0.4 mg) was given prior to stent deployment. Changes in heart rate, blood pressure, and neurological status were monitored and recorded. Potential predictors of HI were tested in multivariate analysis using binary logistic regression model.
Results:
A total of 728 patients were enrolled. Two hundred twenty seven patients (31.2%) developed periprocedural HI. The presence of hypertension (OR, 2.037; 95% CI, 1.292-3.211; P = 0.0022), symptomatic carotid lesions (OR, 1.704; 95% CI, 1.057-2.747; P = 0.0287), right sided lesions (OR, 3.090; 95% CI, 1.934-4.935; P ≤ 0.0001), hyperechoic/calcified plaques (OR, 2.195; 95% CI, 1.458-3.304; p P = 0.0002), and longer lesions (OR, 1.043; 95% CI, 1.012-1.076; P = 0.0072) were significant predictable factors for the occurrence of HI. On the other hand, smoking was significantly associated with a 48.1% decrease in risk of development of HI (OR, 0.519; 95% CI, 0.358-0.754; P = 0.0006). There were no statistically significant differences in periprocedural morbidity or mortality between patients with and without HI.
Conclusion:
HI occurs in a considerable percentage of patients undergoing CAS. Hypertension, right sided, symptomatic carotid lesions, calcified plaques, and longer lesions were shown to be independent risk factors for the development of periprocedural HI. Conversely, smoking demonstrated a protective effect. HI did not appear to predispose to periprocedural adverse events.
