Vasopressor use in the critical care unit for treatment of persistent post-carotid artery stent induced hypotension.
BACKGROUND
Hypotension is common following carotid artery stenting (CAS), and may be mediated by vagal stimulation and/or suppression of spinal sympathetic outflow. Both mixed alpha/beta agonists (dopamine (DA)), and more selective alpha- agonists (norepinephrine (NE) and phenylephrine (PE)), have been used, but the most effective treatment of post-CAS hypotension is unknown.


METHODS
We analyzed data for consecutive patients requiring vasopressor treatment of post-CAS hypotension. The treating physician made choice of vasopressor. Endpoints included infusion duration, coronary care unit (CCU) length of stay (LOS), and any major adverse events (death, stroke, myocardial infarction, arrhythmia).


RESULTS
During the study period, CAS stenting was performed in 623 patients. CCU admission in atropine non-responders for vasopressor treatment was required in 42 patients (6.7%). DA was used in 20 patients (48%), NE in 13 patients (31%), and PE in nine patients (21%). Vasopressor infusion time was 31.8 +/- 10.6 h for DA, compared with 23.8 +/- 8.1 h for NE (P = 0.052) and 22.1 +/- 6.1 h (P = 0.028) for PE. CCU LOS was 46.5 +/- 14.1 h for DA compared with 36.9 +/- 9.1 h for the NE and PE groups combined (P = 0.056). Major adverse events were more common in patients receiving DA than among patients receiving NE or PE (P = 0.04).


CONCLUSIONS
Compared with DA, treatment of post-CAS hypotension with a selective alpha-agonist (NE or PE) is associated with shorter drug infusion time, shorter CCU LOS, and fewer major adverse events.
Division of Cardiovascular Medicine, Washington Hospital Center and Georgetown University, 106 Irving st NW, #3200N, Washington, DC 20010, USA. Nandalur@hotmail.com
Mohan Reddi
MR
Nandalur
Howard
H
Cooper
Lowell F
LF
Satler
Kiran R
KR
Nandalur
John R
JR
Laird
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000601:surgery*; D015331:Cohort Studies; D003422:Critical Care; D004298:Dopamine / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D010656:Phenylephrine / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004298:Dopamine; D009638:Norepinephrine