Risk Factors of Postprocedural Hypotension following Carotid Artery Stenting

Abstract

This study is performed to investigate risk factors of hypotension in response to elective carotid stenting. Forty-four lesions of 40 consecutive patients (mean age 70.4 ± 8.2 years) were retrospectively analyzed. Easy Wall stent was applied in 15 lesions and SMART stent in 29 lesions. We investigated correlations between the occurrence rate of postoperative hypotension below 90 mmHg and persisting over three hours and findings of preoperative angiograms, ultrasonograms and clinical characteristics. Postprocedural hypotension occurred in 19 patients (47.5%) and medical treatment (intravenous administration of catecholamines) was required in eleven patients (27.5%). Although there was no permanent neurological deficits related with postprocedural hypotension, transient neurological deficits were found in three patients. Risk factors of prolonged postprocedural hypotension were statistically analyzed. On angiographic characteristics; 1) distance between the carotid bifurcation and the lesion with maximum stenosis (≦10 mm vs. >10 mm: p = 0.031), 2) type of stenosis (eccentric vs. concentric: p = 0.014) On ultrasonographic characteristics; 1) calcifications at the carotid bifurcation (present vs. absent: p<0.001). Other variables, including age and degree of stenosis, were not associated with postprocedural hypotension after carotid stenting. These angiographic and ultrasonographic variables can be used to identify patients at risk for postprocedural hypotension after carotid stenting. Such identification may help in selection of patients who will benefit from appropriate pharmacological treatment.

Multivariable Analysis of Patients With Severe Persistent Postprocedural Hypotension After Carotid Artery Stenting

“…21 This wide variation is primarily a consequence of inconsistency in the definition of PPH. 24,28–31 This study demonstrated significant associations between the development of PPH and severe lesion calcification, specific EPDs and stents, and contrast volume on univariable analysis. Both the contrast volume and stent type were independent predictors of PPH.…”

“…Additionally, Nonaka et al 31 have also demonstrated that shorter stents generate greater radial force than do longer stents of the same design and diameter. This is an important observation because lesions close to the carotid bifurcation (<10 mm) are implicated in hemodynamic instability 41 and are more likely to have been treated with shorter stents.…”

Treatment via oral midodrine in a patient with prolonged hypotension following carotid artery stenting: a case report

“…Studies show that 5–47% of patients undergoing CAS may develop hemodynamic complications [ 5 – 9 ]. Asymptomatic stenosis, stenosis proximity to bifurcation, calcification at the bifurcation, eccentric stenosis, and dilation percentage may predict the risk of hemodynamic complications of CAS [ 10 , 11 ]. Post-CAS hypotension correlates with higher risk of stroke/transient ischemic attack (TIA), myocardial infarction (MI), prolonged hospital stay (> 1 day), and in-hospital mortality [ 12 ]⁠.…”