Incidence of Hemodynamic Depression After Carotid Artery Stenting Using Different Self-Expandable Stent Types

Abstract

The rates of hemodynamic depression (HD) and thromboembolism were compared in 95 carotid artery stenting (CAS) procedures performed in 87 patients with severe carotid artery stenosis using self-expandable braided Elgiloy stents (Wallstent) in 52 and slotted-tube Nitinol stents (Precise) in 43 procedures. The blood pressure, pulse rate, and neurological signs were recorded at short intervals during and after CAS. All patients underwent diffusion-weighted magnetic resonance imaging within 5 days after the procedure. The incidences of hypotension, bradycardia, and both were 17.9%, 3.2%, and 11.6%, respectively. The rate of postprocedural HD was 23.1% with Wallstent and 44.2% with Precise; the difference was significant (p ＝ 0.025). No patient manifested major cardiovascular disease after CAS. Diffusion-weighted magnetic resonance imaging revealed thromboembolism after 26.9% and 34.9% of Wallstent and Precise stent placement procedures, respectively; the difference was not significant. The type of self-expandable stent placed may affect the risk of procedural HD in patients undergoing CAS. Postprocedural HD was resolved successfully by the administration of vasopressors and by withholding antihypertensive agents.

Comparison of short-term outcomes after carotid artery stenting according to different stent designs

“…It can occur during or after CAS due to over-stretching of the carotid sinus baroreceptors by the balloon or the stent [25]. In our study, the rate of hypotension was higher in the closed-cell stent than the open-cell stent group.…”

Carotid Artery Stenting–Induced Hemodynamic Instability

“…18 Furthermore, nitinol stents are associated with a higher risk of HI as compared to braided elgiloy stents (Wallstents), which can be attributed to the substantial lower radial force exerted by Wallstents in c o m p a r i s on t o o t her se l f -e x pa nd in g stents. 23,32 Several measures for preventing postprocedural HI have been applied. Prudent volume expansion in all patients before the procedure is a safe measure for prevention of HI.…”

Medical Textiles as Vascular Implants and Their Success to Mimic Natural Arteries

“…Similarly, compression of atherosclerotic region requires high radial compression strength, which is generally achieved by increasing mesh density. However, an inverse effect of high mesh density is increased stent stiffness (radial and longitudinal), which has a negative impact on the host artery hemodynamics [ 84 , 85 ]. The arterial length covered by the stent becomes non-compliant and results in pressure attenuation across this region and localised increase in pulse-wave velocity.…”