title: Hemodynamic instability after carotid artery angioplasty and stent placement: a review of the literature.
abstract: In this review of the literature the goal was to determine the frequency and relevance of hemodynamic instability after carotid artery (CA) angioplasty and stent placement. Hemodynamic instability after CA angioplasty and stent placement is a well-recognized phenomenon that occurs in 29 to 51% of patients undergoing the procedure. In some patients this problem is severe enough to warrant treatment with vasopressor agents. Features observed on clinical and angiographic evaluation can help clinicians identify patients who are at risk. Hemodynamic fluctuations encountered as a result of CA angioplasty and stent placement may have adverse clinical consequences, including a higher incidence of myocardial infarction and stroke. Proposed measures to prevent this complication include prophylactic placement of transvenous pacemakers or pretreatment with atropine. Unfortunately, no randomized trials are currently available to assess the efficacy of these approaches. Hemodynamic instability is a common finding after CA angioplasty and stent placement. Clinicians can predict which patients are at risk by considering angiographic and clinical features.
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
mesh_terms: D017130:Angioplasty / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D015607:Stents / Q000009:adverse effects*