Predictive Nomogram for Prolonged Hemodynamic Instability After Carotid Artery Stenting.

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.