Hemodynamic instability following carotid artery stenting

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Postprocedural hypotension and bradycardia are important complications of carotid artery stenting (CAS) and are referred to as hemodynamic instability (HI). However, the incidence and impact of HI on the short-term prognosis of patients have been of a large debate.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Twenty-seven patients were selected based on NASCET criteria, and they underwent CAS between September 2008 and September 2009. Continuous electrocardiography monitoring and supine blood pressure (BP) monitoring were performed before and after stent deployment and on the following day to detect HI, defined as systolic BP lower than 90 mm Hg or a heart rate lower than 60 bpm. Patients were asked to perform a Valsalva maneuver before and after stent deployment. The Valsalva ratios (VRs) along with other demographic and procedural data were documented and compared between patients with and without incidence of HI.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Seventeen patients (63%) developed HI after CAS. The degree of stenosis was found to have a significant correlation with occurrence of HI (p &lt; 0.006). No other risk factor or demographic data showed any correlation with HI. The VRs were significantly lower in the HI group compared with the non-HI group, indicating a significant autonomic dysfunction (p &lt; 0.003). During follow-up, 1 patient (4.3%) developed major stroke, and the remaining patients were symptom free.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Hemodynamic instability occurs frequently after CAS, but it seems to be a benign phenomenon and does not increase the risk of mortality or morbidity in the short term. A VR at rest less than 1.10, baseline autonomic dysfunction, and degree of carotid artery stenosis can be used as measures for predicting HI after CAS.</jats:p></jats:sec>

The correlation between the cardiovascular instability and the size of the developed ischaemic lesions in patients who underwent carotid stenting

“…On the contrary just a few studies have examined the effect of intraprocedural cardiac instability. [18][19][20] Our study demonstrates that balloon catheter dilatation with stent implantation and the cardiac instability during the whole procedure do not significantly increase the number of MR detectable ischaemic lesions and extension 24 hours after the procedure. Only patients with over 160 mmHg systolic BP approached the level of significance.…”

Hemodynamic instability predicts in-hospital and 1-year mortality after transcarotid artery revascularization and transfemoral carotid stenting

“…Known complications after CAS include postprocedural stroke, MI, and death. 9,15,[19][20][21] In this study, it was revealed that there was a significantly increased risk of in-hospital stroke, death, MI, and bleeding as well as the composite endpoints of combined in-hospital stroke and death and combined in-hospital stroke, death and MI for patients that required intravenous medications for postprocedural blood pressure alterations, regardless of whether it was for hypertension or hypotension. The risk of in-hospital complications for the patients that experienced HI was several orders of magnitude greater than for patients that did not require IVBPmed.…”

“…However, although IVBPmed after CAS have been a therapeutic consideration, there remains some debate regarding their true benefit. Many studies have demonstrated that the majority of incidents of HI after CAS are benign, 9,11,12,15,19 and opponents of IVBPmed use after CAS have postulated that prophylactic use of these medications may result in unnecessary hemodynamic strain, leading to increased cardiac or neurologic stress. 14 Still, other studies have shown that there is a decreased incidence of postoperative complications with prophylactic and early treatment of HI.…”

Predisposing Factors and Management of Hemodynamic Depression Following Carotid Artery Stenting

“…[ 1 ] HD is considered to be persistent if there is a fall in SBP for more than 1 hour or if hypotension mandates use of continuous vasopressor administration. [ 2 ]…”