Clinical analysis of patients with hemodynamic depression after carotid artery stenting
Peng Wei1, Qi Deng2, Chao Wen1
1Department of Neurology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, Shanxi Province, China.
Insights
Persistent hemodynamic depression (p-HD) after carotid artery stenting (CAS) affects 18.5% of patients. Hypertension, prior stroke/TIA, CAD, and lesion distance are key predictors, increasing stroke risk and ICU stays.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- Hemodynamic depression (HD) is a known complication following carotid artery stenting (CAS).
- Predicting postoperative risk factors and clinical outcomes, particularly in high-risk individuals, remains challenging.
- Persistent HD (p-HD) and obstinate persistent HD (op-HD) require further investigation regarding their incidence and clinical significance post-CAS.
Purpose of the Study:
- To determine the incidence rate of p-HD and op-HD after CAS.
- To identify clinical predictors associated with p-HD development.
- To evaluate the clinical significance and impact of p-HD/op-HD on perioperative adverse events, specifically stroke.
Main Methods:
- Retrospective analysis of 162 patients with carotid arteriosclerotic stenosis (CASS) undergoing CAS between September 2020 and September 2022.
- Logistic regression analysis to identify independent predictors of p-HD.
- Assessment of pathological associations between p-HD/op-HD and 30-day clinical events, including stroke and ICU length of stay.
Main Results:
- The incidence of p-HD was 18.5% (30/162 patients), and op-HD was 5.6% (9/162 patients).
- Independent predictors for p-HD included hypertension (OR: 8.73), history of stroke/transient ischemic attack (TIA) (OR: 4.05), coronary artery disease (CAD) (OR: 3.38), and lesion distance from carotid bifurcation (OR: 2.467).
- Patients with p-HD or op-HD experienced significantly longer ICU stays (P < 0.001) and a higher risk of stroke (P = 0.003 for p-HD, P < 0.001 for op-HD).
Conclusions:
- Hypertension, prior stroke/TIA, CAD, and lesion proximity to the carotid bifurcation are significant predictors of p-HD post-CAS.
- Both p-HD and op-HD are associated with adverse clinical outcomes, including prolonged ICU admission and increased stroke risk.
- These findings highlight the importance of identifying high-risk patients for p-HD to mitigate potential complications after CAS.
Abstract:
Hemodynamic depression (HD) is a complication after carotid artery stenting (CAS). However, there are existing controversies in predicting postoperative risk factors and subsequent clinical outcomes, especially in high-risk patients. Therefore, the present study aimed to investigate the rate of incidence, clinical predictors, and clinical significance associated with persistent HD (p-HD) pathology, as well as obstinate persistent HD (op-HD) after CAS in our center. We retrospectively analyzed 162 consecutively recruited carotid arteriosclerotic stenosis (CASS) patients who received interventional therapy in our hospital between September 2020 and September 2022. The acute/subacute effects of proximal internal CAS on p-HD and op-HD were studied to explore the relationship between CAS and perioperative adverse events. Logistic regression analysis was performed to identify independent predictors of p-HD after CAS. Pathological associations between p-HD/op-HD and clinical events at the 30-day time point were analyzed. Of 162 patients, 18.5 % (n = 30) patients had p-HD, while op-HD was observed in 5.6 % (n = 9) of patients. Hypertension (OR: 8.73; 95 % CI: 1.05-72.90; P = 0.045), history of stroke/transient ischemic attack (TIA) (OR: 4.05; 95 % CI: 1.55-10.59; P = 0.004), coronary artery disease (CAD) (OR: 3.38; 95 % CI: 1.29-8.89; P = 0.013), and distance from the carotid bifurcation to the lesion with maximum stenosis (OR: 2.467; 95 % CI: 1.02-5.93; P = 0.044) were significantly associated with p-HD onset. Patients with either p-HD or op-HD suffered from longer intensive care unit (ICU) stays (all P < 0.001) and were associated with a higher risk of stroke (P = 0.003; P < 0.001). Our data suggest that hypertension, previous stroke/TIA, CAD, and distance from the carotid bifurcation to the lesion with maximum stenosis may play roles in the development of p-HD after CAS. Moreover, this study indicates that either p-HD/op-HD can be associated with the risk of clinical adverse events, especially stroke.
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