Carotid sinus reactions during carotid artery stenting: predictors, incidence, and influence on clinical outcome.
Carotid sinus reactions (CSR), defined as asystole >/= 3 sec and hypotension (systolic blood pressure </= 90 mm Hg), are frequent events during carotid artery stenting (CAS). Factors predisposing a patient to CSR as well as the impact of CSR on periprocedural complications have not yet been investigated in a prospective manner. The relationship between various clinical, morphologic, and procedural variables and the occurrence of CSR was examined among 105 consecutive patients undergoing successful CAS. After predilatation with a compliant balloon, tubular-slotted stents were used in all patients. No CSR occurred in 63 (60%) patients, whereas CSR developed in 42 (40%) patients. The most common type of CSR was asystole in combination with short-term hypotension without clinical symptoms. The most important predictor of CSR was bifurcation location of carotid stenosis (bifurcation > ostial > isolated internal carotid artery; P < 0.001). The other independent predictors were presence of contralateral stenosis (P < 0.02), length of stenosis (P < 0.03), and balloon-to-artery ratio (P < 0.02). Occurrence of CSR was unrelated to periprocedural cerebral or cardiovascular complications (7.1% vs. 9.5%; NS). We conclude that CSR occurs frequently (40%) during CAS. Bifurcation location of stenosis is the most important predictor of CSR. CSR does not increase the risk of periprocedural complications.
Leisch
Franz
F
Cardiovascular Division, General Hospital, Linz, Austria. franz.leisch@akh.linz.at
Kerschner
Klaus
K
Hofmann
Robert
R
Steinwender
Clemens
C
Grund
Michael
M
Bibl
Dietmar
D
Leisch
Franz A
FA
Bergmann
Hans
H
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000379:methods; D002346:Carotid Sinus / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D015607:Stents; D015996:Survival Rate; D018608:Ultrasonography, Doppler / Q000379:methods