Complications and predictors associated with persistent hemodynamic depression after carotid artery stenting
Introduction
Hemodynamic depression (HD), which includes hypotension and bradycardia, is a frequent phenomenon during and after carotid artery stenting (CAS) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. A recent review reported that the frequency of HD was 7.2–80% [1]. At present, many studies reported that HD was a process of CAS and did not significantly increase the periprocedural complications [1], [5], [11], [13], [15]. But in several large sample studies, persistent HD (PHD, defined as HD lasting more than 1 h, in spite of treating with fluid or vasoactive agent) was associated with more ischemic events, such as stroke and/or myocardial infarction (MI) [4], [10], [12]. So far, only a few studies analyzed the predictors associated with PHD [4], [7], which reported the effect of clinical and vascular morphologic variables on PHD. We presumed that surgical factors may also affect the occurrence of PHD. Through study, this article reported the complications associated with PHD and further analyzed the predictors associated with PHD based on clinical, vascular morphologic and surgical factors. The definition of HD adopted in this study is the most popular definition: systolic blood pressure <90 mm Hg and heart beat rate <60/min [1], [4], [9], [12], [15], [16], [17], [18], [19], [20], [21].
Section snippets
Subjects and methods
We retrospectively analyzed 204 consecutive patients with carotid stenosis treated with CAS between January 2011 and November 2013 in Department of Neurology of the Third Affiliated Hospital of Soochow University and Dongfang Hospital. The inclusion criteria of patients who underwent CAS were symptomatic carotid stenosis >50% and asymptomatic >70%, and >45 years of age. Exclusion criteria were the following: thrombocytopenia (<100 × 109/L), leukopenia (<4 × 109/L), neutropenia, cerebral hemorrhage
Results
Of the total 204 patients, 139 were male and 65 were female. The mean age was 64.45 ± 8.84 years old. All of the patients had successful treatment of the carotid lesion by angioplasty and/or stenting. 34 patients received a simultaneous bilateral stenting. Out of 204 patients, 43 developed PHD (21.08%). In PHD group, the complications occurred in 9 patients (angina pectoris 2, MI 1, cerebral infarction (CI) 3, transient ischemic attack (TIA) 2 and intestinal obstruction 1), which was
Discussion
As one of the most frequent adverse events triggered by CAS during and after the procedure, HD was previously thought to be triggered by the baroreceptors in the carotid sinus. When carotid sinus baroreceptors are dilated and expanded by the balloon or stents, the impulses from the baroreceptors translate to the nucleus tractus solitarius in the medulla. Stimulation from the nucleus tractus solitarius travels to the peripheral vascular, inhibits vessel construction, and ultimately leads to a
Conclusion
PHD may result in more clinical events after CAS. The patients with diabetes, more severe calcified plaque and more balloon dilation pressure are easier to develop PHD after CAS.
References (31)
- et al.
Rate, predictors and consequences of hemodynamic depression after carotid artery stenting
J Am Coll Cardiol
(2006) - et al.
Analysis of parameters associated with hypotension requiring vasopressor support after carotid angioplasty and stenting
J Vasc Surg
(2006) - et al.
Is haemodynamic depression during carotid stenting a predictor of periprocedural complications?
Eur J Vasc Endovasc Surg
(2008) - et al.
Predictors of clinically significant postprocedural hypotension after carotid endarterectomy and carotid angioplasty with stenting
J Vasc Surg
(2009) - et al.
Periprocedural hemodynamic instability with carotid angioplasty and stenting
Surg Neurol
(2008) - et al.
Quantification of coronary artery calcium using ultrafast computed tomography
J Am Coll Cardiol
(1990) - et al.
Electron beam computed tomographic coronary calcium scanning a review and guidelines for use in asymptomatic persons
Mayo Clin Proc
(1999) - et al.
Noninvasive investigation of autonomic activity after carotid stenting or carotid endarterectomy
J Vasc Surg
(2006) - et al.
Carotid artery stenting-induced hemodynamic instability
J Endovasc Ther
(2013) - et al.
Effect of treatment of carotid artery stenosis on blood pressure a comparison of hemodynamic disturbances after carotid endarterectomy and endovascular treatment
Stroke
(2003)
Hypotension and bradycardia after elective carotid stenting frequency and risk factors
J Endovasc Ther
Carotid sinus reactions during carotid artery stenting: predictors, incidence and influence on clinical outcome
Catheter Cardiovasc Interv
Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting
Stroke
Prediction of prolonged postprocedural hypotension after carotid artery stenting
Neurosurgery
Hemodynamic instability during carotid artery stenting the relative contribution of stent deployment versus balloon dilation
J Neurosurg
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These authors contributed equally to this work and share first authorship.