Periprocedural hemodynamic instability with carotid angioplasty and stenting.
BACKGROUND
Carotid angioplasty and stenting is used for treatment of carotid stenosis. Stent deployment may induce HDI and thereby cause systemic or neurologic deficits. This study defines characteristics and predictors of HDI with CAS.


METHODS
A total of 132 patients who had undergone CAS were evaluated for periprocedural and postprocedural HDI (hypertension, systolic blood pressure >160 mm Hg; hypotension, systolic blood pressure <90 mm Hg; or bradycardia, heart rate <60 beats per minute).


RESULTS
Frequencies of HDI were 6.8% for hypertension, 32.6% for hypotension, and 15.9% for bradycardia. In addition, CAS of the right side (P < .01), carotid bulb lesions (P < .05), eccentric posterior carotid plaque (P < .0001), and general anesthesia (P < .05) were associated significantly with postprocedural HDI. Male sex (OR, 3.4; 95% CI, 1.8-67.2; P < .001), age of 80 years or older (OR, 0.4; 95%CI, 0.1-1.4; P = .011), and plaque ulceration (OR, 0.5; 95% CI, 0.1-9.5; P = .008) independently predicted postprocedural hypertension. Male sex (OR, 2.5; 95% CI, 1.3-24.9; P < .001), preprocedural major stroke (OR, 0.1; 95% CI, 0.01-0.8; P = .002), carotid bulb lesions (OR, 1.6; 95% CI, 1.1-25.9; P = .024), and contralateral carotid occlusion (OR, 0.6; 95% CI, 0.2-4.9; P = .040) all predicted postprocedural hypotension. Bradycardia was associated with diabetes mellitus (OR, 0.7; 95% CI, 0.3-2.4; P = .033), preprocedural TIA (OR, 1.7; 95% CI, 1.4-17.9; P = .020), and minor stroke (OR, 1.5; 95% CI, 1-10.9; P = .037). In 5 patients, HDI predisposed neurologic or systemic deterioration.


CONCLUSIONS
Hemodynamic instability is common with CAS; hypotension and bradycardia are more frequent than hypertension. Some clinical, angiographic, and procedural variables can predict these HD changes.
Taha
Mahmoud M
MM
Neurosurgery Department, Mie University School of Medicine, Mie, Japan. mahmoudlotfy1972@yahoo.co.uk
Toma
Naoki
N
Sakaida
Hiroshi
H
Hori
Kotaro
K
Maeda
Masayuki
M
Asakura
Fumio
F
Fujimoto
Masashi
M
Matsushima
Satoshi
S
Taki
Waro
W
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001919:Bradycardia / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D007022:Hypotension / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control