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Predictors of hemodynamic instability during and persistent after carotid artery stenting
Hongchen Zhao1, Zigao Wang1, Yifeng Ling1
1Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China PR.
Insights
Smoking history, carotid bifurcation lesions, and large balloon use predict severe hemodynamic instability after carotid artery stenting. General anesthesia offers intraoperative protection, while long stents may reduce persistent instability.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Neurosurgery
Background:
- Severe hemodynamic instability is a complication of carotid artery stenting (CAS).
- Predictors for this complication remain incompletely understood.
- Identifying these factors is crucial for patient safety during CAS.
Purpose of the Study:
- To identify independent risk factors for severe hemodynamic instability during and after CAS.
- To analyze predictors of intraoperative and postoperative hemodynamic instability.
- To investigate factors associated with persistent hemodynamic instability post-CAS.
Main Methods:
- Retrospective analysis of 139 consecutive patients undergoing CAS for extracranial carotid artery stenosis.
- Assessment of intraoperative and postoperative hemodynamic instability.
- Statistical analysis to identify predictive factors using odds ratios and p-values.
Main Results:
- 63 patients (45%) experienced severe hemodynamic instability.
- Independent risk factors included smoking exposure, carotid bifurcation stenosis, and large-diameter balloon dilatation (>4 mm).
- General anesthesia and longer stenosis-to-bifurcation distance were protective intraoperatively; long stents (40 mm) may reduce persistent instability.
Conclusions:
- Smoking, lesions near the carotid bulb, and large balloon dilatation are associated with increased risk of hemodynamic instability.
- General anesthesia provides intraoperative protection.
- Long-stent implantation may mitigate persistent hemodynamic instability.
Objectives:
The risk factors for post-carotid artery stenting severe hemodynamic instability remain elusive. This study aimed to identify the predictors of severe hemodynamic instability during and persisted after carotid artery stenting.
Materials And Methods:
Consecutive patients who underwent carotid artery stenting for extracranial carotid artery stenosis at a single-center between September 2018 and July 2021 were retrospectively assessed. The predictive factors of severe hemodynamic instability intraoperation and post-operation were analyzed.
Results:
Among the 139 patients included, 63 experienced severe hemodynamic instability, with 45 and 18 cases occurring intra and postoperatively, respectively. Persistent was observed in 21 patients. Smoke exposure (odds ratio [OR], 2.38; p=0.039), carotid bifurcation stenosis (OR, 0.91; p=0.018), and large-diameter balloon (>4 mm) dilatation (OR, 11.95; p<0.001) were identified as independent risk factors for hemodynamic instability at any stage of carotid artery stenting. Intraoperatively, large-diameter balloon (>4 mm) dilatation was associated with an increased risk of hemodynamic instability occurrence (OR, 4.67; p=0.01), whereas general anesthesia (OR, 0.19; p=0.001) and a longer distance from the stenosis to the carotid bifurcation (OR, 0.89; p=0.01) were negatively associated with hemodynamic instability. Furthermore, smoking exposure (OR, 3.73; p=0.03), large diameter balloon dilatation (OR, 6.12; p=0.032), distance from stenosis to bifurcation (OR, 0.85; p=0.047) and long-stent (40 mm) implantation (OR, 0.84 [95% confidence interval, 0.74-0.95]; p=0.007) could independently predict persistent hemodynamic instability.
Conclusion:
Patients with a smoking history, lesions near the carotid bulb, or dilatation using a large-diameter balloon were most likely to suffer severe hemodynamic instability. General anesthesia can protect against severe hemodynamic instability only intraoperatively. Long-term stent implantation may reduce persistent hemodynamic instability.
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