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CLINICAL RESEARCH

Rate, Predictors, and Consequences of Hemodynamic Depression After Carotid Artery Stenting

Rishi Gupta, MD^_*,, Alex Abou-Chebl, MD^_*, Christopher T. Bajzer, MD, H. Christian Schumacher, MD and Jay S. Yadav, MD^_*,,_*

^_* Interventional Neurology, Section of Stroke and Neurological Critical Care
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Department of Neurology, University of Pittsburgh Medical Center, Stroke Institute, Pittsburgh, Pennsylvania
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York

Manuscript received April 20, 2005; accepted August 22, 2005.

^_* Reprint requests and correspondence: Dr. Jay S. Yadav, Cleveland Clinic Foundation, 9500 Euclid Avenue, F25, Cleveland, Ohio 44195 (Email: yadavj{at}ccf.org).

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 pressure <90 mm Hg) or bradycardia (heart rate <60 beats/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.

Abbreviations and Acronyms   CAS = carotid artery stenting   CEA = carotid endarterectomy   DM = diabetes mellitus   HD = hemodynamic depression   HR = heart rate   MACE = major adverse clinical events   MI = myocardial infarction   NS = normal saline   OR = odds ratio   SBP = systolic blood pressure   TIA = transient ischemic attack

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