Incidence, predictors, and outcomes of hemodynamic instability following carotid angioplasty and stenting.
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 pressureHg), and/or bradycardia (heart rateminute), 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.
Published In/Presented At
Ullery, B. W., Nathan, D. P., Shang, E. K., Wang, G. J., Jackson, B. M., Murphy, E. H., Fairman, R. M., & Woo, E. Y. (2013). Incidence, predictors, and outcomes of hemodynamic instability following carotid angioplasty and stenting. Journal of vascular surgery, 58(4), 917–925. https://doi.org/10.1016/j.jvs.2012.10.141
Medicine and Health Sciences
Department of Medicine, Cardiology Division