title: Improved hemodynamic outcomes with glycopyrrolate over atropine in carotid angioplasty and stenting.
abstract: OBJECTIVE
  Prophylactic atropine traditionally has been used to prevent CAS-associated hemodynamic depression. Glycopyrrolate may serve as an alternative with decreased cardiac effects. This study aims to compare the efficacy of prophylactic glycopyrrolate to atropine in preventing CAS-induced hemodynamic instability and cardiac complications.
  
  
  METHODS
  115 consecutive CAS patients from 2004-2010 were evaluated. Primary endpoints were stroke, MI, bradycardia (HR<60 beats/min), and hypotension (systolic BP <90 mm Hg). Additional outcomes included tachycardia (HR >100 beats/min), hypertension (systolic BP >160 mm Hg), pre- and postoperative systolic BP difference, vasopressor use, arrhythmias, cardiac enzyme elevations, and access site complications.
  
  
  RESULTS
  Of 115 patients, 65 (56.5%) patients who received atropine or glycopyrrolate prior to CAS were analyzed [40 (61.5%) patients received glycopyrrolate, 25 (38.5%) received atropine]. Mean age was 70.0 ± 8.5 years (range, 48-86 years). Mean stenosis was 86.2 ± 7.4% (range, 70-99%). No MI, major stroke, or death was observed in the 30-day postoperative period. Baseline systolic BP and HR were equivalent between groups. Postoperative bradycardia and hypotension were significantly lower in glycopyrrolate patients compared with atropine patients (30% vs 72%, P = .002; 2.5% vs 36%, P < .001, respectively). Postoperative hypertension was also significantly lower in the glycopyrrolate cohort (2.5% vs 16%, P = .047), whereas tachycardia, pressure changes, vasopressor use, and cardiac complications did not differ significantly. No significant differences in neurologic and access site complications were observed.
  
  
  CONCLUSIONS
  Prophylactic glycopyrrolate, compared with atropine, reduces hemodynamic instability during CAS. The authors recommend glycopyrrolate use to prevent CAS-induced bradycardia and hypotension.
authors.affiliation: Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Chung
authors.forename: Neal S
authors.initials: NS
authors.lastname: Cayne
authors.forename: Mark A
authors.initials: MA
authors.lastname: Adelman
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Riles
authors.forename: Patrick
authors.initials: P
authors.lastname: Lamparello
authors.forename: Daniel
authors.initials: D
authors.lastname: Han
authors.forename: Michael L
authors.initials: ML
authors.lastname: Marin
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001285:Atropine / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006024:Glycopyrrolate / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D009519:New York City; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018727:Muscarinic Antagonists; D001285:Atropine; D006024:Glycopyrrolate