Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting.
Publication/Presentation Date
4-18-2006
Abstract
OBJECTIVES: We sought to determine the frequency, predictors, and consequences of hemodynamic depression (HD) after carotid artery stenting (CAS).
BACKGROUND: Hemodynamic depression has been reported after carotid artery stenting CAS and carotid endarterectomy (CEA).
METHODS: We retrospectively analyzed data on 500 consecutive CAS procedures performed over a 5-year period. Hemodynamic depression was defined as periprocedural hypotension (systolic blood pressureHg) or bradycardia (heart rate/s). Univariate and multivariate binary logistic regression models were used to determine the predictors and consequences of HD and persistent HD.
RESULTS: The mean age of the patients was 70.5 +/- 10 years, and 69% were men. Hemodynamic depression occurred during 210 procedures (42%), whereas persistent HD developed in 84 procedures (17%). Features that independently predicted HD included lesions involving the carotid bulb (odds ratio [OR] 2.18 [range 1.46 to 3.26], p < 0.0001) or the presence of a calcified plaque (OR 1.89 [range 1.25 to 2.84], p < 0.002). Prior ipsilateral CEA was associated with reduced risk of HD (OR 0.35 [range 0.20 to 0.60], p < 0.0001). Patients who developed persistent HD were at a significantly increased risk of a periprocedural major adverse clinical event (OR 3.05 [range 1.35 to 5.23], p < 0.02) or stroke (OR 3.34 [range 1.13 to 9.90], p < 0.03).
CONCLUSIONS: Hemodynamic depression is common after CAS, particularly in patients with a calcified plaque in the carotid bulb, but is easily treated with conventional methods. Patients who develop persistent HD are at an increased risk of periprocedural major adverse clinical events and stroke.
Volume
47
Issue
8
First Page
1538
Last Page
1543
ISSN
1558-3597
Published In/Presented At
Gupta, R., Abou-Chebl, A., Bajzer, C. T., Schumacher, H. C., & Yadav, J. S. (2006). Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting. Journal of the American College of Cardiology, 47(8), 1538–1543. https://doi.org/10.1016/j.jacc.2005.08.079
Disciplines
Medicine and Health Sciences
PubMedID
16630988
Department(s)
Department of Medicine
Document Type
Article