Impact of Periprocedural Hemodynamic Depression on Outcomes After Carotid Artery Stenting: A Systematic Review and
Xin Liu1, Xiaowei Liu2,3,4,5,6, Yunsen Zhang2
1Department of Orthopedics, Chengdu Second People's Hospital, Jinjiang District, Chengdu, 610000, China.
Insights
Hemodynamic depression during carotid artery stenting (CAS) is linked to higher risks of stroke, transient ischemic attack (TIA), and death. However, this study found no significant association between hemodynamic depression and myocardial infarction (MI) risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Carotid Artery Stenting (CAS) is a common procedure to prevent stroke.
- Hemodynamic depression (HD) is a potential complication during CAS.
- The association between HD during CAS and major adverse cardiovascular events (MACE) requires further clarification.
Purpose of the Study:
- To evaluate the association between hemodynamic depression (HD) during CAS and major adverse cardiovascular events (MACE).
Main Methods:
- Systematic literature search of four databases for studies on HD and MACE during CAS.
- Risk of bias assessed using a modified Newcastle-Ottawa scale.
- Heterogeneity evaluated using I² statistic and Dixon's Q-test; fixed-effect or random-effects models applied based on heterogeneity.
Main Results:
- 14 studies with 4418 patients included in the meta-analysis.
- Low-certainty evidence shows HD significantly associated with increased risk of stroke (OR 2.12), TIA (OR 2.72), and all-cause mortality (OR 2.81).
- Very low-certainty evidence suggests no significant association between HD and myocardial infarction (MI) (OR 1.49).
Conclusions:
- Hemodynamic depression during CAS is significantly associated with an increased risk of TIA, stroke, and all-cause mortality.
- No significant association was found between HD during CAS and the risk of myocardial infarction (MI).
- Further research with higher certainty evidence is warranted to confirm these findings.
Purpose:
To evaluate the association between hemodynamic depression (HD) during CAS and major adverse cardiovascular events (MACE).
Methods:
We systematically searched four major databases for studies reporting the HD and MACE during CAS. The risk of bias in the included studies was assessed using a modified version of Newcastle-Ottawa scale. The heterogeneity between the studies was evaluated based on the I2 statistic and Dixon's Q-test. We assessed heterogeneity using the I2 statistic. A fixed-effect model was used if I2 < 50%; otherwise, a random-effects model was applied. Results were reported as ORs with 95% CIs. Funnel plots and Egger's test were used to evaluate the publication bias.
Results:
Fourteen studies comprising 4418 patients were included in the meta-analysis. Evidence of low certainty indicated that the occurrence of HD was significantly associated with an increased risk of stroke (OR 2.12, 95% CI 1.4-3.22, I2 = 0), transient ischemic attack (TIA) (OR 2.72, 95% CI 1.51-4.88, I2 = 41.2), and all-cause mortality (OR 2.81, 95% CI 1.22-6.44, I2 = 0). However, very low-certainty evidence suggested no significant association between HD and myocardial infarction (MI) (OR 1.49, 95% CI 0.61-3.61, I2 = 0).
Conclusions:
HD during CAS is significantly associated with a risk of TIA, stroke, and all-cause mortality, but not with the risk of MI.
