Influence of stent type on hemodynamic depression after carotid artery stent placement.
OBJECTIVE
To assess the effect of stent type on hypotension and bradycardia after carotid artery stent placement.


METHODS
A retrospective analysis on a prospectively maintained database was conducted in 256 patients (126 men; mean age, 71.8 years +/- 8.6; 194 de novo lesions) undergoing carotid artery stent placement between January 1996 and January 2007 by using self-expanding stents. Braided Elgiloy stents (Wallstents) were used in 44 of the 256 patients (17.2%) and slotted-tube nitinol stents were deployed in 212 (82.8%). Bivariate and multivariable logistic regression models were used to determine the influence of stent design on procedural and 24-hour hypotension and bradycardia.


RESULTS
Procedural hemodynamic depression (HD) was encountered in 73 of the 256 patients (28.5%) due to hypotension in 24 (9.4%), bradycardia in 12 (4.7%), or both in 37 (14.5%) patients. Rates of procedural hypotension were 11.3% with nitinol stents and 0% with braided Elgiloy stents (P = .0188). Persistent postprocedural HD occurred in 91 of the 256 patients (35.5%) due to hypotension in 40 patients (15.6%), bradycardia in 23 (9.0%), or both in 28 (10.9%). Within a multivariable analysis adjusted for clinically relevant factors affecting rates of HD, the use of braided Elgiloy stents was associated with a decreased rate of procedural hypotension (odds ratio: 0.165; 95% confidence interval: 0.038, 0.721; P = .017). Procedural hypotension and bradycardia were not correlated to incidence of major adverse events but were associated with an increased duration of hospital stay (P = .0059 and P = .0335, respectively).


CONCLUSIONS
Nitinol stents are associated with a higher risk of hypotension as compared to braided Elgiloy stents during carotid artery stent placement.
Diehm
Nicolas
N
Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA.
Katzen
Barry T
BT
Dick
Florian
F
Kovacs
Margaret
M
Zemel
Gerald
G
Powell
Alex
A
Samuels
Shaun
S
Benenati
James F
JF
D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001919:Bradycardia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol