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Geometric distribution of plaque calcification is associated with postprocedural hypotension after carotid artery

Zhicai Chen1, Hui Cheng2, Qiongyin Zhang3

  • 1Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine; State Key Laboratory of Transvascular lmplantation Devices, Hangzhou, Zhejiang, China.

Journal of Neurointerventional Surgery
|February 8, 2025
PubMed

Insights

Dorsal plaque calcification after carotid artery stenting (CAS) significantly increases the risk of postprocedural hypotension. This finding aids in predicting and managing hypotension following CAS procedures.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Neurology
  • Medical Imaging

Background:

  • Carotid artery stenting (CAS) is a common procedure to treat carotid artery stenosis.
  • Postprocedural hypotension is a known complication following CAS.
  • The geometric distribution of plaque calcification has not been fully explored as a predictor of postprocedural hypotension.

Purpose of the Study:

  • To investigate the relationship between the geometric distribution of plaque calcification and postprocedural hypotension after CAS.
  • To identify specific plaque characteristics that may predict the occurrence of hypotension.

Main Methods:

  • Retrospective analysis of 477 patients undergoing CAS between April 2018 and February 2023.
  • Evaluation of plaque calcification using cross-sectional images and segmentation into four quadrants (interior, exterior, ventral, dorsal).
  • Definition of postprocedural hypotension as persistent systolic blood pressure <90 mmHg requiring vasopressors for over 1 hour.

Main Results:

  • 41 patients (8.6%) experienced postprocedural hypotension.
  • Plaque calcification in the dorsal quadrant was significantly more frequent in the hypotension group.
  • Dorsal calcification independently predicted postprocedural hypotension (OR 3.520, p=0.004).

Conclusions:

  • Dorsal plaque calcification, identified by a modified geometric method, is associated with a threefold increased risk of postprocedural hypotension after CAS.
  • These findings can inform patient screening, procedural planning, and management strategies to mitigate hypotension risk.
  • Further research may refine risk stratification and improve patient outcomes.
Abstract

Keywords:
CT AngiographyInterventionStentStroke

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