title: Hypotension and bradycardia after elective carotid stenting: frequency and risk factors.
abstract: OBJECTIVE
  To investigate the frequency of and risk factors for hypotension and bradycardia in response to elective carotid stenting and their association with neurological complications.
  
  
  METHODS
  A retrospective analysis was conducted of 471 patients (321 men; median age 72 years, interquartile range 64-77) who underwent elective carotid artery stenting without cerebral protection for high-grade (>70%) symptomatic (n=147) or asymptomatic (n=324) internal carotid artery stenosis at a single center. Frequency and potential risk factors for severe hypotension (systolic blood pressure <80 mmHg) or bradycardia (heart rate <50 bpm) were studied.
  
  
  RESULTS
  Thirty-four (7%) patients had severe hypotension (n=23), bradycardia (n=2), or both (n=9) despite routine premedication with atropine and adequate fluid balance. Intravenous catecholamines (dopamine) were necessary in 8 patients with prolonged hypotension; none of the patients with bradycardia needed pacemaker support. Neurological complications (transient ischemic attack, minor stroke, major stroke, death) occurring in 33 (7%) patients were not significantly associated with hemodynamic instability (4/34 [12%] versus 29/437 [7%], p=0.26). Age >77 years (fourth quartile; OR 6.40, 95% CI 1.80 to 22.78, p=0.004) and coronary artery disease (OR 2.81, 95% CI 1.29 to 6.14, p=0.010) were associated with an increased adjusted risk for hypotension or bradycardia.
  
  
  CONCLUSIONS
  Hemodynamic instability due to hypotension and bradycardia in response to carotid artery stenting occurs in a relatively low proportion of patients. Elderly patients and those with coronary artery disease are at highest risk. Although the rate of neurological complications was not significantly increased in patients with hemodynamic instability, the higher frequencies of neurological complications in these patients admonish us to be careful.
authors.affiliation: Department of Angiology, University of Vienna, Medical School, Vienna, Austria. wolfgang.mlekusch@akh-wien.ac.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mlekusch
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
authors.forename: Schila
authors.initials: S
authors.lastname: Sabeti
authors.forename: Tassilo
authors.initials: T
authors.lastname: Nachtmann
authors.forename: Wilfried
authors.initials: W
authors.lastname: Lang
authors.forename: Ramazanali
authors.initials: R
authors.lastname: Ahmadi
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
mesh_terms: D000368:Aged; D001919:Bradycardia / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*