Abstract
To determine the clinical significance of acute hemodynamic disturbances during stenting
in the carotid sinus region, we assessed the relation between intraprocedural changes
in heart rate (HR) and blood pressure (BP) and adverse neurologic and cardiac outcomes.
Eighteen patients underwent carotid stenting with the Wallstent (Schneider Inc). Suitable
candidates had at least 60% diameter stenosis of the carotid artery by angiography.
Initial and nadir HR and BP were recorded during the predilatation, stent delivery,
and postdilatation periods. Bradycardia was defined as HR ≤60 beats/min and hypotension
as systolic BP ≤100 mm Hg. Nineteen Wallstents were successfully deployed in all 19
carotid arteries. Some degree of bradycardia or hypotension occurred in 68% of carotid
stent procedures, but administration of vasoactive medications was necessary in only
7 patients (37%) with more persistent hemodynamic disturbances. Hypotension or the
need for continuous vasopressor therapy was significantly more common during postdilatation
(32%) than in the predilatation period (5%) (p = 0.02). Bradycardia was not reduced
by prophylactic atropine. In 1 patient the hemodynamic response to stenting may have
contributed to an adverse neurologic and cardiac outcome. Thus, despite frequent fluctuations
in HR and BP, most carotid stenting procedures were performed with excellent overall
results, even in patients at high risk.
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Article info
Publication history
Accepted:
May 30,
1998
Received in revised form:
May 28,
1998
Received:
March 6,
1998
Footnotes
☆This study was supported by the National Research Service Award 2T32HL07101-21A from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
