title: Influence of plaque volume on hemodynamic response and stress hormone release in patients undergoing carotid artery stenting.
abstract: OBJECTIVE
  Carotid artery stenting (CAS) may cause bradycardia and hypotension due to barostimulation. The impact of periprocedural hypotension on CAS outcome remains controversial. The role of carotid plaque volume and catecholamine hormone release during CAS on hemodynamic changes has not been investigated so far. The aim of this prospective study was to evaluate if carotid artery plaque characteristics are predictive for stress hormone release or for postprocedural hemodynamic instability.
  
  
  METHODS
  In 26 patients undergoing CAS, carotid plaque volume and morphology were assessed by two- and three-dimensional (3D)-Duplex sonography prior to the procedure. Arterial plasma adrenaline, noradrenaline and renin concentrations were measured at the time of sheath insertion and 5 minutes after stent placement. ECG, heart rate, and invasive blood pressure were monitored throughout the procedure.
  
  
  RESULTS
  CAS caused no significant changes in hormone release, but increasing plaque volume was related to the degree of bradycardia following stent deployment (r=0.57; P=0.01). Plaque size was not associated with postprocedural hypotension. Plaque echogenicity (echolucent, heterogeneous or echogenic) did not correlate with changes in systolic blood pressure, heart rate or catecholamine hormone release.
  
  
  CONCLUSIONS
  CAS caused bradycardia in relation to plaque size, but did not cause catecholamine release which may indicate that the endovascular procedure is not associated with a relevant stress reaction.
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Husmann
authors.forename: C
authors.initials: C
authors.lastname: Thalhammer
authors.forename: S
authors.initials: S
authors.lastname: Spring
authors.forename: T
authors.initials: T
authors.lastname: Meier
authors.forename: M
authors.initials: M
authors.lastname: Roffi
authors.forename: U R S
authors.initials: UR
authors.lastname: Schwarz
authors.forename: V
authors.initials: V
authors.lastname: Rousson
authors.forename: B R
authors.initials: BR
authors.lastname: Amann-Vesti
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001919:Bradycardia / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002395:Catecholamines / Q000097:blood*; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012720:Severity of Illness Index; D015607:Stents; D013312:Stress, Physiological; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D012083:Renin; D009638:Norepinephrine; D004837:Epinephrine