Prediction of Prolonged Postprocedural Hypotension after Carotid Artery Stenting

Author:

Nonaka Tadashi1,Oka Shinichi1,Miyata Kei1,Mikami Takeshi1,Koyanagi Izumi1,Houkin Kiyohiro1,Yoshifuji Kazuhisa1,Imaizumi Toshio1

Affiliation:

1. Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan

Abstract

ABSTRACT OBJECTIVE: Stent placement for the treatment of carotid artery stenosis may cause hemodynamic instability that induces ischemic complications for patients with bilateral carotid lesions. We carried out this study to define predictors of persistent hypotension after carotid stenting. METHODS: Thirty-three lesions in 31 consecutive patients (mean age, 69.2 ± 8.6 yr) who underwent stent deployment for carotid stenosis were studied. Fourteen lesions were treated with Easy Wall stents (Boston Scientific, Tokyo, Japan) and 19 lesions were treated with Smart stents (Johnson & Johnson, Warren, NJ). We reviewed preoperative angiograms and ultrasonograms of the carotid artery and analyzed the predictive factors of postprocedural prolonged hypotension (systolic blood pressure <90 mm Hg and periods >3 h). RESULTS: Postprocedural hypotension was observed in 14 lesions (42.4%), of which medical treatment was necessary in seven (21.2%). A distance between carotid bifurcation and maximum stenotic lesion (≤10 mm; P = 0.0028) and type of stenosis (eccentric; P = 0.0287) on angiogram and fibrous plaque morphological features (P = 0.0008) and calcifications at carotid bifurcation (P = 0.0004) on ultrasonograms were determined to be independent risk factors of postprocedural hypotension. We introduced a scoring system for predicting prolonged hypotension that included factors such as the distance from carotid bifurcation to maximum stenotic lesion (≤10 mm), type of stenosis (eccentric), plaque morphological features (echogenic), and calcification at carotid bifurcation. The score was determined by adding one point for each of these factors. Three points or more on this score strongly suggested a high risk of prolonged hypotension. CONCLUSION: Our scoring system, which includes angiographic and ultrasonographic findings, may be a good index for the prediction of prolonged hypotension after carotid stenting and may contribute to the reduction of periprocedural ischemic events.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference27 articles.

1. Factors associated with perioperative complications during carotid endarterectomy;Asiddao;Anesth Analg,1982

2. Cervical carotid stenosis: Which technique, balloon angioplasty or surgery?;Bergeron;J Cardiovasc Surg,1996

3. The peripheral circulation and its contro;Berne,1993

4. Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy;Bove;Surgery,1979

5. Postprocedural hypotension after carotid artery stent placement: Predictors and short- and long-term clinical outcomes;Dangas;Radiology,2000

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