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General Anesthesia is Associated with Hypotension and Prolonged Length of Stay after Carotid Stent: A Vascular

Alexis X Chen1, Ioannis Tsouknidas2, Kimberly Feeney2

  • 1Philadelphia College of Osteopathic Medicine, Philadelphia, PA.

Annals of Vascular Surgery
|July 27, 2026
PubMed

Insights

Persistent post-procedural hypotension (PPH) is common after carotid artery stenting (CAS). General anesthesia increases PPH risk, while diabetes and male sex appear protective.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Carotid artery stenting (CAS) is a key intervention for carotid artery stenosis.
  • Hemodynamic instability, specifically persistent post-procedural hypotension (PPH), is a recognized complication of CAS.
  • Understanding factors influencing PPH is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To identify demographic and periprocedural factors associated with PPH following CAS.
  • To analyze the incidence and characteristics of PPH in patients undergoing CAS.
  • To evaluate the impact of anesthesia type on PPH and intensive care unit (ICU) admission.

Main Methods:

  • Retrospective review of 236 elective CAS procedures (including Transcarotid Artery Revascularization and transfemoral CAS) from January 2017 to December 2024.
  • Data collected included patient demographics, intraoperative variables, and postoperative outcomes (PPH, ICU admission).
  • Multivariable logistic regression analysis was employed to determine independent predictors of PPH and ICU stay.

Main Results:

  • PPH occurred in 51.7% of CAS procedures, with 56.6% requiring vasopressor support and 51.6% of those with PPH admitted to the ICU.
  • Male sex and diabetes were identified as protective factors against PPH (p=0.03 and p=0.003, respectively).
  • General anesthesia was a significant risk factor for both PPH (p=0.03) and ICU admission (p=0.04).

Conclusions:

  • PPH is a frequent, transient complication after CAS.
  • General anesthesia is associated with an increased risk of PPH and ICU admission.
  • Diabetes and male sex demonstrate a protective effect against PPH in CAS patients.
Abstract

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