Predicting Factors Associated with Postoperative Hypotension following Carotid Artery Stenting

Rubio, Gustavo A.; Karwowski, John K.; DeAmorim, Hilene; Goldstein, Lee J.; Bornak, Arash

doi:10.1016/j.avsg.2018.06.005

Cited by 16 publications

(14 citation statements)

References 17 publications

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“…Hemodynamic instability after CAS has been reported to occur in 5–76% of cases 10 14–16. In addition, the need for vasopressor infusion due to PH has been reported in 12–40% of cases 14 17–19. In this cohort, 24.5% of patients undergoing CAS procedures experienced PH.…”

Section: Discussionmentioning

confidence: 69%

Low left atrial volume is an independent predictor of persistent hypotension after carotid artery stenting

Maekawa

Ohara

Takasugi

et al. 2022

J NeuroIntervent Surg

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BackgroundPersistent hypotension (PH) after carotid artery stenting (CAS) is a relatively common complication; however, it is unclear which patients are more likely to experience this phenomenon. Recently, lower left atrial (LA) volume was associated with vasovagal syncope, which has a similar neurological mechanism to hypotension after CAS. This study aimed to investigate whether LA volume can predict PH after CAS.MethodsThis single center retrospective analysis used data from 316 patients who had undergone CAS between March 2013 and February 2021. After the exclusion of urgent CAS, 212 procedures (202 patients) with transthoracic echocardiograms were included. The procedures were divided among two groups according to the presence or absence of PH for more than 1 hour after CAS.ResultsThe mean age of the patients was 73.0±7.5 years. PH was observed during 52 (24.5%) procedures. The PH group exhibited a lower LA volume index (LAVI) than the no-PH group (29.7±9.1 vs 37.7±12.5 mL/m2, respectively; p<0.001). The area under the receiver operating characteristic curve was 0.716. The optimal cut-off value was 33.5 mL/m2 (sensitivity 0.750, specificity 0.625). Multiple logistic regression analysis showed that LAVI <33.5 mL/m2 was an independent predictor for PH after CAS (OR 4.950, 95% CI 2.190 to 11.200; p<0.001). Preoperative hydration was negatively associated with PH (OR 0.235, 95% CI, 0.070 to 0.794; p=0.020).ConclusionsA lower LA volume can predict PH after CAS, and preoperative hydration may prevent PH after CAS.

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Section: Discussionmentioning

confidence: 69%

Low left atrial volume is an independent predictor of persistent hypotension after carotid artery stenting

Maekawa

Ohara

Takasugi

et al. 2022

J NeuroIntervent Surg

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“…Oshin et al 9 also identified an association between carotid calcification and prolonged vasodepressor response. Calcification as a risk factor for hemodynamic instability has been reported previously, 2,7,8 though this has been inconsistent across studies and not determined to be significant through pooled meta-analysis. 3 Calcification or fibrous tissue may result in more direct force on the carotid bulb compared with a more compliant vessel.…”

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confidence: 88%

“…The typical hypotensive and bradycardic effects that result from carotid sinus baroreceptor stimulation can vary in duration and may necessitate medical intervention. 1–4 Prolonged hypotension following CAS may be associated with adverse patient outcomes, such as an increased risk of cerebrovascular events. 4–6 The pooled incidence of hypotension or bradycardia following CAS has been reported as high as 39%, 3 though estimates vary and are confounded by nonstandardized clinical definitions.…”

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confidence: 99%

“…Carotid bulb calcification has been associated with increased risk of hemodynamic instability following CAS, 2,7,8 though the predisposing risk factors for prolonged hypotension are likely multifactorial and remain incompletely understood. Improved understanding of the predisposing anatomic, patient, and procedural risk factors for developing hemodynamic instability has important implications for patient selection, procedure planning, and establishing expectations for the likely duration of hospitalization.…”

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confidence: 99%

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Commentary: Hypotension After Internal Carotid Artery Stenting: Is It Predictable?

Armstrong

Bricker

2019

J Endovasc Ther

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“…Previous studies have demonstrated that carotid plaque morphology and compositions were associated with perioperative HI. The HI-associated plaque morphological and compositional features include extensive or eccentric lesions, a distance between the carotid bifurcation and maximum stenotic lesion <10 mm, and calcified or fibrous lesions (7)(8)(9). The stiffness of atherosclerotic plaque is associated with vulnerability (10).…”

Section: Introductionmentioning

confidence: 99%

Vulnerable carotid plaque characteristics on magnetic resonance vessel wall imaging: potential predictors for hemodynamic instability during carotid artery stenting

Jiang¹,

Meng²,

Zhao³

et al. 2023

Quant Imaging Med Surg

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Background: This cross-sectional study sought to explore the possible risk factors assessed with magnetic resonance (MR) vessel wall imaging for hemodynamic instability (HI) during carotid artery stenting (CAS).Methods: Patients with carotid stenosis who were referred for CAS from January 2017 to December 2019 were recruited and underwent carotid MR vessel wall imaging. The vulnerable plaque features, including lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), fibrous cap rupture, and plaque morphology, were evaluated. The HI was defined as a drop of systolic blood pressure (SBP) of ≥30 mmHg or the lowest SBP measurement of <90 mmHg after stent implantation. The carotid plaque characteristics were compared between the HI and non-HI groups. The association between carotid plaque characteristics and HI was analyzed.Results: A total of 56 participants (mean age 68.7±8.3 years; 44 males) were recruited. Patients in the HI group (n=26, 46%) had a significantly greater wall area [median 43.2 (IQR, 34.9-50.5) vs. 35.9 (IQR, 32.3-39.4) mm 2 ; P=0.008], total vessel area (79.7±17.2 vs. 69.9±17.3 mm 2 ; P=0.03), prevalence of IPH (62% vs. 30%; P=0.02), prevalence of vulnerable plaque (77% vs. 43%; P=0.01), and volume of LRNC [median 344.7 (IQR, 155.1-665.7) vs. 103.1 (IQR, 53.9-162.9) mm 3 ; P=0.001] in carotid plaque compared to those in non-HI group (n=30, 54%). Carotid LRNC volume (OR =1.005, 95%

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Predicting Factors Associated with Postoperative Hypotension following Carotid Artery Stenting

Cited by 16 publications

References 17 publications

Low left atrial volume is an independent predictor of persistent hypotension after carotid artery stenting

Low left atrial volume is an independent predictor of persistent hypotension after carotid artery stenting

Commentary: Hypotension After Internal Carotid Artery Stenting: Is It Predictable?

Vulnerable carotid plaque characteristics on magnetic resonance vessel wall imaging: potential predictors for hemodynamic instability during carotid artery stenting

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