Hemodynamic instability during carotid artery stenting: the relative contribution of stent deployment versus balloon dilation

Clinical article

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Object

Hemodynamic instability may complicate carotid angioplasty and stenting in up to 40% of patients. The authors have previously demonstrated that primary self-expanding stent placement alone can gradually dilate severely stenosed carotid arteries without the use of balloons. The authors hypothesized that eliminating the balloon would reduce carotid baroreceptor stimulation, thereby decreasing the incidence of hemodynamic instability.

Methods

Ninety-seven high surgical risk patients with symptomatic, severely stenosed carotid arteries were treated with the intention of using a self-expanding stent alone. Seventy-seven arteries (79%) were treated with stenting alone, and 20 required angioplasty (21%).

Results

Intraprocedural bradycardia (heart rate < 60 bpm) developed in 29 patients (38%) and hypotension (systolic blood pressure < 90 mm Hg) occurred in 1 patient (1%) treated with stenting alone. Fourteen patients (70%) who underwent angioplasty and stenting had bradycardia, and hypotension developed in 4 (20%). Atropine, glycopyrrolate, or vasopressors were required in 8% of patients who received stenting alone, compared to 30% of patients who underwent angioplasty. In the first 24 hours after treatment, hypotension or bradycardia developed in 25 patients (32%) who had undergone stent placement alone, and in 15 patients (75%) after stent placement and balloon angioplasty. There was no difference in the occurrence of intra- or postprocedural hypertension (systolic blood pressure > 160 mm Hg) between patients treated with stenting alone or stenting and balloons. Factors independently associated with hemodynamic depression included baseline heart rate and balloon use.

Conclusions

Hemodynamic instability during and after carotid artery stenting was observed more frequently when balloon angioplasty was required than when stent placement was performed without concurrent balloon angioplasty.

Abbreviations used in this paper: CAS = carotid angioplasty and stenting; DBP = diastolic blood pressure; HD = hemodynamic depression; SBP = systolic blood pressure; SES = self-expanding stent.
Article Information

Contributor Notes

Address correspondence to: Miguel Bussière, M.D., Ph.D., Neurology and Interventional Neuroradiology, The Ottawa Hospital Civic Campus, C2, Room 2174, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9. email: mbussiere@toh.on.ca.
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References
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