Postprocedural hypotension after carotid artery stent placement: predictors and short- and long-term clinical outcomes.
OBJECTIVE
To describe the predictors of persistent hypotension after carotid artery stent (CAS) placement and define the clinical outcome of patients with this hemodynamic disturbance.


METHODS
One hundred forty CAS procedures were performed in 133 consecutive patients. Post-CAS hypotension-defined as a greater than 40 mm Hg decrease in arterial pressure without evidence of hypovolemia, with a systolic pressure lower than 90 mm Hg at the end of CAS and lasting at least 1 hour-was observed in 25 patients (group 1); 108 patients did not have hypotension (group 2).


RESULTS
Post-CAS hypotension developed in 33.9% of cases after balloon-expandable stent placement versus in 13.6% of cases after self-expanding stent placement (P =.04). In-hospital minor ipsilateral strokes occurred in 16% of cases in group 1 versus in 3% of cases in group 2 (P =.03). There was one (0.9%) major stroke (transient) and three (2.6%) transient ischemic attacks, all of which occurred in group 2 (not significant vs group 1 for both conditions). At 10 months +/- 4 (SD) of follow-up, there was greater total mortality in group 1 than in group 2 (20% vs 4%, P =.02), whereas neurologic events did not differ significantly between the groups.


CONCLUSIONS
Hypotension due to carotid sinus stimulation is frequent after CAS with balloon-expandable stents. This phenomenon correlates with increased in-hospital complications and long-term risk of death.
Dangas
G
G
Division of Cardiology and the Departments of Neuroradiology and Neurology, Washington Hospital Center, Washington, DC, USA.
Laird
J R
JR
Satler
L F
LF
Mehran
R
R
Mintz
G S
GS
Larrain
G
G
Lansky
A J
AJ
Gruberg
L
L
Parsons
E M
EM
Laureno
R
R
Monsein
L H
LH
Leon
M B
MB
D000368:Aged; D000369:Aged, 80 and over; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography