Prolonged hypotension after carotid artery stenting: incidence, predictors and consequences

Gökçal, Elif; Niftaliyev, Elvin; Deniz, Çiğdem; Ergelen, Mehmet; Güzel, Vildan; Göktekín, Ömer; Asıl, Talip

doi:10.1007/s00701-017-3295-9

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…A total of 1430 literature records were retrieved, including 435 records in Chinese and 995 records in English. Finally, 17 3 –5,7,10 –12,17 –26 studies were finally included in the meta-analysis. The flow of the literature screening process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…The 17 3 –5,7,10 –12,17 –26 studies included 7 3,7,11,17 –20 case-control studies and 10 4,5,10,12,21 –26 cross-sectional studies. In addition, the sample contained a total sample size of 2843 cases, as well as 897 patients with postoperative hypotension and 14 patients with exposure factors (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…This may result in a greater risk of severe hemodynamic flow disturbances. 30,34 –36 Liu et al 18 found that bilateral CAS placement improved cerebral blood supply, thereby regulating blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors for hypotension after carotid artery stenting: Systematic review and meta-analysis

Yang

Liu

et al. 2023

International Journal of Stroke

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Objective: Hypotension is recognized as a common complication after carotid artery stenting, but its incidence and the risk factors associated with it are uncertain. Therefore, we performed a systematic review and meta-analysis to investigate and identify risk factors for hypotension after surgery. Methods: We retrieved risk factors from eight databases for case-control and cross-sectional studies of hypotension after carotid artery stenting according to PRISMA guidelines on Nov. 28th, 2022. Data were analyzed by using R4.2.1 and Review Manager 5.3. Results: A total of 2,843 samples were searched, and 17 publications were included in the analysis. The meta-analysis results showed that the incidence of hypotension after surgery was 28.6% (95% CI [0.225,0.347]). Age ≥65 years (OR=4.55, 95% CI [2.50, 8.29], P＜0.00001), stenosis site (bulb) (OR=4.41, 95% CI [2.50, 7.79], P<0.00001), severe stenosis (OR= 3.56, 95% CI [1.62, 7.85], P=0.002), stenosis proximity (≤10 mm) to bifurcation (OR=2.69, 95% CI [1.74, 4.15], P<0.00001), calcified plaques (OR=4.64, 95% CI [1.93, 11.14], P=0.0006), post-balloon dilation (OR=5.95, 95% CI [2.31, 15.31], P=0.0002), bilateral carotid stenting (OR=30.51, 95% CI [2.33, 399.89], P=0.009), and intravenous fluid intake/mL on the first postoperative day (MD=444.99, 95% CI [141.40, 748.59], P=0.004) were risk factors for hypotension after surgery. Conclusions: A high incidence of hypotension was observed after carotid artery stenting. Age, stenosis site, severe stenosis, stenosis proximity to bifurcation, calcified plaques, post-balloon dilation, type of surgery, and intravenous fluid intake were identified as risk factors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Incidence and risk factors for hypotension after carotid artery stenting: Systematic review and meta-analysis

Yang

Liu

et al. 2023

International Journal of Stroke

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“…Several physicians demonstrated this phenomenon through an intraluminal rub test and observed that patients with contralateral stenosis were more likely to have a significant hypotensive response. 18 It has been hypothesized that the carotid sinus may have physiologic baroreceptor reserve, 19 which is impaired in bilateral carotid artery stenosis. This may explain why patients with contralateral stenosis are more susceptible to PHD during or after CAS.…”

Section: The Risk Factors For Phdmentioning

confidence: 99%

Persistent Hemodynamic Depression After Carotid Artery Stenting: A Review and Update

Liu

Zheng

et al. 2022

Vasc Endovascular Surg

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According to the American Heart Association, ischemic stroke is the second leading cause of death globally and is responsible for approximately 11% of deaths. Carotid endarterectomy (CEA) is the standard treatment for moderate or severe extracranial internal carotid artery (ICA) stenoses. With the development of materials and technology in neurointervention, the Centers for Medicare and Medicaid Services (CMS) have proposed that carotid artery stenting (CAS) can serve as an alternative treatment for CEA. As CAS is widely used worldwide, comorbidities, especially persistent hemodynamic depression (PHD) and stroke, have attracted public attention. In this review, we summarized the current advances in PHD after CAS. A better understanding of CAS-related PHD may inspire the design of potential prognostic and therapeutic tools.

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“…The incidence of this vasodepressor reaction ranges between 5 and 76%, whereas the incidence of persistent hypotension ranges between 11 and 35%. [ 3 4 5 6 7 8 9 ] Variation in incidence across the studies can be largely explained because of the differences in definition, inclusion criteria and procedural technique. In a meta-analysis of 27 randomised trials with over 4000 patients, the pooled estimate for hypotension was 12.1%, 19.2% for persistent hypotension, 12.2% for bradycardia, and 12.5% for both hypotension and bradycardia.…”

Section: Efinition Of Hdmentioning

confidence: 99%

Predisposing Factors and Management of Hemodynamic Depression Following Carotid Artery Stenting

Sudheer

Agarwal

Vishnu

et al. 2021

Annals of Indian Academy of Neurology

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Carotid artery stenting (CAS) involves dilatation of carotid bulb which can trigger a series of neuronal responses resulting in hemodynamic depression that might influence the outcome of the procedure. This is a frequent but underdiagnosed complication of CAS. Although it is mild, transient and self-limiting in majority of cases, it can result in significant morbidity and mortality if persistent. Neurologists should be aware of the predisposing factors and management of this common complication. In patients who present with stroke following carotid stenting, neurologists should be aware of hypoperfusion secondary to hemodynamic depression as a cause of stroke apart from the stent thrombosis and occlusion.

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Prolonged hypotension after carotid artery stenting: incidence, predictors and consequences

Cited by 13 publications

References 30 publications

Incidence and risk factors for hypotension after carotid artery stenting: Systematic review and meta-analysis

Incidence and risk factors for hypotension after carotid artery stenting: Systematic review and meta-analysis

Persistent Hemodynamic Depression After Carotid Artery Stenting: A Review and Update

Predisposing Factors and Management of Hemodynamic Depression Following Carotid Artery Stenting

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