title: Hemodynamic instability following carotid artery stenting.
abstract: OBJECTIVE
  Postprocedural hypotension and bradycardia are important complications of carotid artery stenting (CAS) and are referred to as hemodynamic instability (HI). However, the incidence and impact of HI on the short-term prognosis of patients have been of a large debate.
  
  
  METHODS
  Twenty-seven patients were selected based on NASCET criteria, and they underwent CAS between September 2008 and September 2009. Continuous electrocardiography monitoring and supine blood pressure (BP) monitoring were performed before and after stent deployment and on the following day to detect HI, defined as systolic BP lower than 90 mm Hg or a heart rate lower than 60 bpm. Patients were asked to perform a Valsalva maneuver before and after stent deployment. The Valsalva ratios (VRs) along with other demographic and procedural data were documented and compared between patients with and without incidence of HI.
  
  
  RESULTS
  Seventeen patients (63%) developed HI after CAS. The degree of stenosis was found to have a significant correlation with occurrence of HI (p < 0.006). No other risk factor or demographic data showed any correlation with HI. The VRs were significantly lower in the HI group compared with the non-HI group, indicating a significant autonomic dysfunction (p < 0.003). During follow-up, 1 patient (4.3%) developed major stroke, and the remaining patients were symptom free.
  
  
  CONCLUSIONS
  Hemodynamic instability occurs frequently after CAS, but it seems to be a benign phenomenon and does not increase the risk of mortality or morbidity in the short term. A VR at rest less than 1.10, baseline autonomic dysfunction, and degree of carotid artery stenosis can be used as measures for predicting HI after CAS.
authors.affiliation: Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran. kojurij@yahoo.com
authors.forename: Javad
authors.initials: J
authors.lastname: Kojuri
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Ostovan
authors.forename: Nima
authors.initials: N
authors.lastname: Zamiri
authors.forename: Sara
authors.initials: S
authors.lastname: Farshchizarabi
authors.forename: Bahman
authors.initials: B
authors.lastname: Varavipoor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001919:Bradycardia / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D016893:Carotid Stenosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*