title: Incidence, predictors, and outcomes of hemodynamic instability following carotid angioplasty and stenting.
abstract: OBJECTIVE
  To explore the incidence, predictors, and outcomes of hemodynamic instability (HI) following carotid angioplasty and stenting (CAS).
  
  
  METHODS
  We retrospectively evaluated data on 257 CAS procedures performed in 245 patients from 2002 to 2011 at a single institution. The presence of periprocedural HI, as defined by hypertension (systolic blood pressure >160 mm Hg), hypotension (systolic blood pressure <90 mm Hg), and/or bradycardia (heart rate <60 beats per minute), was recorded. Clinically significant HI (CS-HI) was defined as periprocedural HI lasting greater than 1 hour in total duration. Logistic regression was used to analyze the role of multiple demographic, clinical, and procedural variables.
  
  
  RESULTS
  Mean age was 70.9 ± 9.9 years (67% male). HI occurred following 84% (n = 216) of procedures. The incidence of hypertension, hypotension, and bradycardia was 54%, 31%, and 60%, respectively. Sixty-three percent of cases involved CS-HI. Recent stroke was an independent risk factor for the development of CS-HI (odds ratio, 5.24; confidence interval, 1.28-21.51; P = .02), whereas baseline chronic obstructive pulmonary disease was protective against CS-HI (odds ratio, 0.34; confidence interval, 0.15-0.80; P = .01). Patients with CS-HI were more likely to experience periprocedural stroke compared to other patients (8% vs 1%; P = .03). There were no significant differences in the incidence of mortality or other major complications between those with and without CS-HI.
  
  
  CONCLUSIONS
  HI represents a common occurrence following CAS. While the presence of periprocedural HI alone did not portend a worse clinical outcome, CS-HI was associated with increased risk of stroke. Expeditious intervention to prevent and manage CS-HI is of critical importance in order to minimize adverse clinical events following CAS.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Brant W
authors.initials: BW
authors.lastname: Ullery
authors.forename: Derek P
authors.initials: DP
authors.lastname: Nathan
authors.forename: Eric K
authors.initials: EK
authors.lastname: Shang
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Erin H
authors.initials: EH
authors.lastname: Murphy
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001919:Bradycardia / Q000453:epidemiology / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D007022:Hypotension / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015143:Philadelphia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome