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Severe hemodynamic depression after carotid artery stenting: The problem overcome with a transvenous temporary
Masako Fujii1, Takeshi Satow1, Hiroshi Kodama2
1Department of Neurosurgery, Nagahama City Hospital, Nagahama, Shiga, Japan.
Insights
Transvenous temporary cardiac pacing (TTCP) can prevent hemodynamic depression after carotid angioplasty stenting (CAS). Smoking and calcified plaque are key predictors, guiding patient selection for TTCP before CAS.
Area of Science:
- Cardiovascular Interventions
- Neurosurgery
- Critical Care Medicine
Background:
- Carotid angioplasty stenting (CAS) carries risks, including perioperative hemodynamic depression.
- Transvenous temporary cardiac pacing (TTCP) is a potential preventative measure against circulatory failure during CAS.
- Identifying predictors of hemodynamic depression is crucial for selecting patients who may benefit from preoperative TTCP.
Observation:
- An 84-year-old male with asymptomatic severe left carotid stenosis underwent CAS.
- A TTCP was proactively implanted due to anticipated hemodynamic depression risk.
- Post-CAS, the patient experienced severe hypotension and cardiac arrest, successfully managed with TTCP activation and vasopressors.
Findings:
- A literature review identified smoking (OR 1.68) and severely calcified plaque (OR 3.70) as significant predictors of perioperative hemodynamic depression after CAS.
- These factors indicate an increased risk of adverse hemodynamic events during or after the procedure.
Implications:
- TTCP is recommended for patients undergoing CAS, especially those with a history of smoking or severely calcified plaques.
- Proactive TTCP implantation can mitigate severe complications and improve patient outcomes following CAS.
- This strategy enhances patient safety in high-risk CAS procedures.
Background:
Carotid angioplasty stenting (CAS) may have adverse events including perioperative hemodynamic depression. A transvenous temporary cardiac pacemaker (TTCP) is an option for preventing devastating sequelae due to circulatory failure. An exploration of the predictors of hemodynamic depression following CAS is valuable for selecting candidates for preoperative TTCP implantation before CAS.
Case Description:
An 84-year-old man underwent CAS for asymptomatic left carotid severe stenosis. He had no history of bradycardia arrhythmia. A TTCP was implanted in advance in view of the likelihood of perioperative hemodynamic depression. CAS was accomplished successfully, but severe hypotension and vanishing of self-heartbeat occurred about 90 min after the procedure. By activating the pre-implanted TTCP, spontaneous circulation was readily recovered with vasopressor administration. He was discharged with no additional neurological deficits. A literature review using a random effect model found that smoking (odds ratio [OR] 1.68, 95% confidence interval (CI) 1.13-2.52) and severely calcified plaque (OR 3.70, 95% CI 2.15-6.35) were significant predictors of perioperative hemodynamic depression following CAS.
Conclusion:
TTCP can be recommended for a patient receiving CAS to prevent catastrophic consequences, particularly in cases with a history of smoking or severely calcified plaque.
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