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Risk factors for hemodynamic depression after carotid artery stenting: A system review and meta analysis
Xiaowei Liu1, Bei Pan2, Yunsen Zhang3
1The First school of Clinical Medicine, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
Insights
Hemodynamic depression (HD) occurs in 35% of patients undergoing carotid artery stenting (CAS). Risk factors include diabetes, specific stenosis characteristics, plaque type, and stent design, highlighting areas for improved patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Hemodynamic depression (HD) is a frequent complication during carotid artery stenting (CAS).
- HD can lead to adverse clinical events, necessitating identification of its causes.
- Understanding HD incidence and risk factors is crucial for patient safety during CAS.
Purpose of the Study:
- To determine the incidence of hemodynamic depression during carotid artery stenting.
- To identify key risk factors associated with hemodynamic depression in patients undergoing CAS.
- To provide evidence-based insights for mitigating HD during CAS procedures.
Main Methods:
- A systematic literature search was conducted across four major databases.
- Included studies reporting HD incidence or risk factors during CAS were assessed for bias.
- A meta-analysis pooled prevalence rates and risk factors using a randomized effects model.
Main Results:
- The meta-analysis included 53 articles, revealing an overall HD incidence of 35%.
- Significant risk factors identified include diabetes, short stenosis-to-bifurcation distance (<10 mm), carotid bulb involvement, calcified and eccentric plaques, severe stenosis, contralateral stenosis, open-cell stents, and bilateral stenting.
- Odds ratios (OR) with 95% confidence intervals (CI) were calculated for each risk factor.
Conclusions:
- Diabetes, specific anatomical and plaque characteristics, and stent types are significantly associated with HD during CAS.
- These findings underscore the importance of pre-procedural assessment and tailored approaches in CAS.
- Further research may focus on preventative strategies targeting these identified risk factors.
Purpose:
Hemodynamic depression (HD) regularly occurs during carotid artery stenting(CAS) for treating carotid stenosis and it could result in adverse clinical events. This review aimed to clarify the incidence and risk factors for HD.
Methods:
We searched four comprehensive databases for studies that reported the incidence or risk factors for HD during CAS. We used a modified version of Newcastle-Ottawa scale to assess the risk of bias in the included studies. We pooled the prevalence rates of HD and related risk factors from individual studies with a generic inverse variance weighted using the randomized effects model. We reported the results using OR with 95 % CI. Funnel plots and Egger's tests were used to assess the publication bias.
Results:
Our meta-analysis enrolled 53 articles and revealed that the incidence of HD was 35 %. Patients who had diabetes (OR = 1.28, 95 % CI: 1.07 to 1.54), stenosis-to-bifurcation <10 mm (OR = 2.11, 95 % CI: 1.29 to 3.48), stenosis involving the carotid bulb (OR = 1.9, 95 % CI: 1.07 to 3.38), calcified plaque (OR = 2.06, 95 % CI: 1.32 to 3.22), eccentric plaque (OR = 1.47, 95 % CI: 1.05 to 2.05), severe stenosis (OR = 1.64, 95 % CI: 1.1 to 2.43), contralateral stenosis (OR = 2.02, 95 % CI: 1.18 to 3.46), open-cell stents (OR = 1.5, 95 % CI: 1.04 to 2.15), and bilateral stenting (OR = 2.32, 95 % CI: 1.56 to 3.44) showed a higher risk of HD.
Conclusions:
Diabetes, stenosis-to-bifurcation <10 mm, stenosis involving the carotid bulb, calcified plaque, eccentric plaque, severe stenosis, contralateral stenosis, open-cell stents, and bilateral carotid stenting were associated with HD during CAS.
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