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Acute hemodynamic changes during carotid artery stenting
F O Mendelsohn1, N J Weissman, R J Lederman
1Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Insights
Acute hemodynamic disturbances like bradycardia and hypotension are common during carotid stenting but rarely lead to adverse outcomes. Most procedures show excellent results, even in high-risk patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Neurology
Background:
- Carotid artery stenosis poses a significant risk for stroke.
- Carotid stenting is an established treatment option for high-grade stenosis.
- Hemodynamic changes during stenting can impact patient outcomes.
Purpose of the Study:
- To evaluate the clinical significance of hemodynamic disturbances during carotid stenting.
- To correlate intraprocedural heart rate (HR) and blood pressure (BP) changes with adverse neurologic and cardiac events.
Main Methods:
- Nineteen patients with >60% carotid artery stenosis underwent stenting with Wallstent.
- Intraprocedural HR and BP were monitored during predilatation, stent delivery, and postdilatation.
- Bradycardia and hypotension were defined and analyzed in relation to procedural phases.
Main Results:
- Hemodynamic disturbances (bradycardia/hypotension) occurred in 68% of procedures.
- Persistent disturbances requiring medication were noted in 37% of patients.
- Hypotension was significantly more frequent during postdilatation (32%) versus predilatation (5%).
- Prophylactic atropine did not reduce bradycardia.
Conclusions:
- Despite frequent hemodynamic fluctuations during carotid stenting, most procedures yield excellent results.
- Adverse neurologic and cardiac outcomes are rare, even in high-risk patients.
- Careful monitoring and management of hemodynamic changes are important during carotid stenting.
Abstract:
To determine the clinical significance of acute hemodynamic disturbances during stenting in the carotid sinus region, we assessed the relation between intraprocedural changes in heart rate (HR) and blood pressure (BP) and adverse neurologic and cardiac outcomes. Eighteen patients underwent carotid stenting with the Wallstent (Schneider Inc). Suitable candidates had at least 60% diameter stenosis of the carotid artery by angiography. Initial and nadir HR and BP were recorded during the predilatation, stent delivery, and postdilatation periods. Bradycardia was defined as HR < or =60 beats/min and hypotension as systolic BP < or =100 mm Hg. Nineteen Wallstents were successfully deployed in all 19 carotid arteries. Some degree of bradycardia or hypotension occurred in 68% of carotid stent procedures, but administration of vasoactive medications was necessary in only 7 patients (37%) with more persistent hemodynamic disturbances. Hypotension or the need for continuous vasopressor therapy was significantly more common during postdilatation (32%) than in the predilatation period (5%) (p = 0.02). Bradycardia was not reduced by prophylactic atropine. In 1 patient the hemodynamic response to stenting may have contributed to an adverse neurologic and cardiac outcome. Thus, despite frequent fluctuations in HR and BP, most carotid stenting procedures were performed with excellent overall results, even in patients at high risk.