Predictive Nomogram for Prolonged Hemodynamic Instability After Carotid Artery Stenting
Mingxing Liu1, Yong Zhou1, Tong Li1
1Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, P.R. China.
Insights
Intraoperative hemodynamic instability (HI), large balloons, 7-10mm stents, and post-balloon dilation predict prolonged HI after carotid artery stenting (CAS). A new nomogram aids in preoperative risk stratification for CAS patients.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Neurosurgery
Background:
- Hemodynamic instability (HI), characterized by hypotension and/or bradycardia, is a frequent complication within 6 hours post-carotid artery stenting (CAS).
- Prolonged HI necessitates careful management due to an elevated risk of neurological complications.
Purpose of the Study:
- To determine the incidence of prolonged hemodynamic instability (HI) following CAS.
- To identify potential predictive factors for prolonged HI after CAS.
Main Methods:
- A retrospective study involving patients undergoing CAS from January 2023 to January 2025.
- Logistic regression analysis was employed to identify predictors of prolonged HI, with a nomogram developed for risk stratification.
- Predictive performance was assessed using ROC, Hosmer-Leme, and decision curve analyses.
Main Results:
- Intraoperative HI, use of large balloons, 7-10mm stents, and post-balloon dilatation were identified as significant independent predictors of prolonged HI.
- The developed nomogram demonstrated high predictive accuracy in both training and validation cohorts (AUC=0.92).
- The nomogram proved superior to the All or None scheme in decision curve analysis for risk stratification.
Conclusions:
- Intraprocedural HI, large balloons, large-diameter stents (7-10mm), and post-balloon dilatation are independent risk factors for prolonged HI post-CAS.
- The developed nomogram offers a precise tool for preoperative risk stratification in patients undergoing CAS.
- This tool can aid clinicians in anticipating and managing prolonged HI, potentially reducing associated neurological complications.
Background:
Hemodynamic instability (HI), manifesting as hypotension and/or bradycardia, presents a common complication within 6 h post-CAS. The prolonged HI requires particular attention due to increased risk of neurologic complications.
Aims:
The study aimed to determine the incidence and potential predictive factors of prolonged hemodynamic instability (HI) after carotid artery stenting (CAS).
Methods:
From January 2023 to January 2025, patients diagnosed with carotid artery stenosis underwent CAS treatment were recruited. The data of peri-procedural characteristics extracted from the Hospital electronic database. Prolonged HI was defined as post-procedural HI persisting beyond 24 h, with or without associated symptoms. Logistic regression identified predictors of HI. A nomogram was developed based on the regression analysis. The receiver operating characteristic (ROC), Hosmer-Leme and decision curve analyses were used to assess predictive performance.
Results:
The training cohort consisted of 234 cases, while the validation cohort included 100 cases. The logistic regression identified intraoperative HI (OR = 2.77, p = 0.02), Large balloon (OR = 10.53, p < 0.001), 7-10 mm stent (OR = 12.72, p < 0.001), and post balloon dilatation (OR = 2.60, p = 0.041) as significant independent predictors of HI. The external validation cohort demonstrated strong calibration curves between predicted and observed outcomes (p = 0.21). Decision curves confirmed the nomogram's superiority over the All or None scheme, particularly within threshold probabilities of > 5% to < 95%. The nomogram's performance metrics were: AUC = 0.92, accuracy = 0.89, specificity = 0.94, sensitivity = 0.94, PLR = 5.8, NLR = 0.07, and DOR = 82.25.
Conclusion:
This study confirms that intraprocedural HI, Large balloon, large-diameter stent use (7-10 mm), and post-balloon dilatation were independent risk factors for prolonged HI following CAS. The integration of these factors into a nomogram provides clinicians with a highly accurate tool for preoperative risk stratification.
