Prediction of Prolonged Hemodynamic Instability During Carotid Angioplasty and Stenting.
OBJECTIVE
The aim of this study was to assess the risk factors of prolonged hemodynamic instability (HDI) after carotid angioplasty and stenting (CAS). Herein, a simplified predictive scoring system for prolonged HDI is proposed.


METHODS
Sixty-six patients who had CAS from 2011 to 2016 at a single institution were evaluated. Prolonged HDI was defined as systolic blood pressure >160 mm Hg or <90 mm Hg or heart rate <50 beats/min, lasting over 30 minutes despite medical treatments. For the study, clinical data and radiologic data, including plaque morphology and stenosis were analyzed.


RESULTS
Prolonged HDI was observed in 21 patients (31.8%). Multivariable analysis revealed that calcification (OR, 6.726; p=0.006), eccentric stenosis (OR, 3.645; p=0.047) and extensive plaque distribution (OR, 7.169; p=0.006) were related to prolonged HDI. According to these results, a simplified scoring scale was proposed based on the summation of points: 2 points for calcified plaque, 2 points for extensive plaque distribution, and 1 point for eccentric stenosis. The percentages of prolonged HDI according to the total score were as follows: score 0, 8.7%; score 1, 20.0%; score 2, 38.5%; score 3, 72.7%; score 4, 66.7%; score 5, 100%. From the analysis, the total score in patients with prolonged HDI was significantly higher than those without prolonged HDI (p<0.001).


CONCLUSIONS
Prolonged HDI can be associated with calcification of plaque, eccentric stenosis and extensive plaque distribution, and a simplified scoring system enables prediction of prolonged HDI according to our cohort.
Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea.
Jong Kook
JK
Rhim
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.
Jin Pyeong
JP
Jeon
Department of Neurology, Konkuk University College of Medicine, Seoul, Korea.
Jeong Jin
JJ
Park
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.
Hyuk Jai
HJ
Choi
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Young Dae
YD
Cho
Department of Neurosurgery, Bundang Jesaeng Hospital, Bundang, Korea.
Seung Hun
SH
Sheen
Department of Neurosurgery, Catholic University College of Medicine, Incheon, Korea.
Kyung-Sool
KS
Jang
Carotid angioplasty and stenting; Hemodynamic instability; Stent