Oral midodrine is effective for the treatment of hypotension associated with carotid artery stenting.
Hypotension is commonly encountered during carotid artery stenting (CAS), mediated by vagal stimulation and suppression of sympathetic outflow. Some patients require treatment with intravenous vasopressors (dopamine, nor-epinephrine, or phenylephrine). The authors describe the successful use of the oral agent midodrine as an alternative to intravenous vasopressors in the treatment of hypotension related to CAS. Of 55 patients who underwent elective CAS, 19 (35%) experienced significant hypotension, and 15 (27%) required vasopressor therapy. Eleven patients received intravenous dopamine infusion in an intensive care setting, whereas 4 received oral midodrine in a regular telemetry unit. All patients eventually recovered and were discharged without any residual cardiovascular or neurological complications. No major side effects were noted with the use of both dopamine and midodrine. Cost of hospitalization was significantly higher in the dopamine group because of the need for ICU admission.
Sharma
Sanjiv
S
Bakersfield Heart Hospital, Bakersfield, California 93308, USA. sanjiv1122@yahoo.com
Lardizabal
Joel A
JA
Bhambi
Brijesh
B
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000601:surgery; D004298:Dopamine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008879:Midodrine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D008879:Midodrine; D004298:Dopamine