Predictors of clinically significant postprocedural hypotension after carotid endarterectomy and carotid angioplasty with stenting

Park, Brian D.; Divinagracia, Thomas; Madej, Olga; McPhelimy, Caitlin; Piccirillo, Bryan; Dahn, Michael S.; Ruby, Steven T.; Menzoı́an, James O.

doi:10.1016/j.jvs.2009.05.005

Cited by 40 publications

(37 citation statements)

References 28 publications

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“…[21][22][23] In the current study, 12% of the patients treated by CAS had periprocedural hemodynamic depression requiring treatment, whereas uncontrolled series of patients treated by CAS have reported frequencies of arterial hypotension or hemodynamic depression ranging from 19% to 51%. 17,19,[24][25][26] This difference may be explained by ascertainment bias because the assessment of hemodynamic depression was a primary aim of some of the observational studies but not of ICSS. In addition, definitions for hypotension or hemodynamic depression as a composite measure differed between ICSS and the observational studies.…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore possible that these could have occurred at any time between the start of the revascularization and discharge. However, based on observations in uncontrolled series, 17,19,[24][25][26] we expect that the majority of hemodynamic events would have occurred during or immediately after CAS or CEA. For this reason, most if not all MRI scans will have been performed after the development of hemodynamic depression.…”

Section: January 2014mentioning

confidence: 99%

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Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Altinbas

Algra

Bonati

et al. 2014

Stroke

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In patients with symptomatic carotid artery stenosis, carotid artery stenting (CAS) is associated with a higher risk of periprocedural stroke than carotid endarterectomy (CEA). 1Patients treated by CAS also more frequently have new ischemic lesions on post-treatment MRI scans with diffusionweighted imaging (DWI). 2 The cause of the higher risk of new cerebral ischemia early after CAS compared with CEA is uncertain.Embolism from the carotid artery plaque during stent deployment or arterial dissection is generally held responsible for the majority of new ischemic lesions during carotid revascularization. During CAS and CEA, cerebral microembolic signals are often detected with transcranial Doppler. 3A high frequency of these signals has been associated with a higher risk of stroke, 4 but the majority of the underlying emboli do not lead to cerebral ischemia.5 It has been proposed that under circumstances of a normal cerebral perfusion, most of these emboli are cleared by the cerebral circulation and that hypoperfusion increases the risk of a focal ischemic lesion. This is supported by a study that showed that patients with impaired perfusion in the hemisphere ipsilateral to the carotid artery stenosis before stenting had more ischemic lesions Background and Purpose-Carotid artery stenting (CAS) is associated with a higher risk of both hemodynamic depression and new ischemic brain lesions on diffusion-weighted imaging than carotid endarterectomy (CEA). We assessed whether the occurrence of hemodynamic depression is associated with these lesions in patients with symptomatic carotid stenosis treated by CAS or CEA in the randomized International Carotid Stenting Study (ICSS)-MRI substudy. Methods-The number and total volume of new ischemic lesions on diffusion-weighted imaging 1 to 3 days after CAS or CEA was measured in the ICSS-MRI substudy. Hemodynamic depression was defined as periprocedural bradycardia, asystole, or hypotension requiring treatment. The number of new ischemic lesions was the primary outcome measure. We calculated risk ratios and 95% confidence intervals per treatment with Poisson regression comparing the number of lesions in patients with or without hemodynamic depression. Results-A total of 229 patients were included (122 allocated CAS; 107 CEA). After CAS, patients with hemodynamic depression had a mean of 13 new diffusion-weighted imaging lesions, compared with a mean of 4 in those without hemodynamic depression (risk ratio, 3.36; 95% confidence interval, 1.73-6.50). The number of lesions after CEA was too small for reliable analysis. Lesion volumes did not differ between patients with or without hemodynamic depression. Conclusions-In

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Section: Discussionmentioning

confidence: 99%

Section: January 2014mentioning

confidence: 99%

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Altinbas

Algra

Bonati

et al. 2014

Stroke

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“…34 With detailed multimodal preoperative assessment and careful determination of angioplasty balloon size, the incidence of prolonged hypotension could be suppressed 10% (8/80) in our study, compared with other studies. 12,13,15,35,36 Once prolonged CSR occurred, continuous intravenous vasopressor infusion was immediately administered with monitoring of vital signs, urine output, and neurologic signs and symptoms. Despite the prevention of excessive hypotension and the maintenance of sufficient urine output, prolonged CSR was an independent risk factor for CIN.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Carotid Sinus Reflex Is a Risk Factor for Contrast-Induced Nephropathy following Carotid Artery Stenting

Kato¹,

Sakai²,

Tsujimoto³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Although many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear. We investigated the incidence of CIN, defined as an increase from a baseline creatinine value of at least 0.5 mg/dL or 25% within 72 hours of contrast administration, and we also examined renal function in the late phase after CAS.

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“…1,3,14 -16 Controlled but nonrandomized studies have suggested that arterial hypotension is a more frequent complication after CAS than after CEA. 17,18 In the randomized Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Baseline measurement is at randomization. Negative within-group scores mean a decrease from baseline.…”

Section: Discussionmentioning

confidence: 99%

Effects of Carotid Endarterectomy or Stenting on Blood Pressure in the International Carotid Stenting Study (ICSS)

Altinbas

Algra

Brown

et al. 2011

Stroke

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Background and Purpose-Arterial hypotension is more frequently observed early after carotid artery stenting (CAS) than after carotid endarterectomy (CEA), but their long-term effects on blood pressure (BP) are unclear. We compared the effects of CAS and CEA on BP up to 1 year after treatment in the International Carotid Stenting Study. Methods-Patients with symptomatic carotid stenosis were randomly allocated to CAS or CEA. Systolic and diastolic BP were recorded at baseline, at discharge, and at 1, 6, and 12 months. Antihypertensive medication use was recorded. A per-protocol analysis was performed. Patients with missing BP records were excluded. Between-group BP changes were compared and adjusted for baseline covariates with linear regression. Within-group BP changes were compared with the paired t test. Results-CAS (Nϭ587) and CEA (Nϭ637) were both associated with a decrease in BP at discharge, which was greater after CAS (mean difference in systolic BP between groups, 10.3 mm Hg; 95% CI, 7.

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Predictors of clinically significant postprocedural hypotension after carotid endarterectomy and carotid angioplasty with stenting

Cited by 40 publications

References 28 publications

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy

Prolonged Carotid Sinus Reflex Is a Risk Factor for Contrast-Induced Nephropathy following Carotid Artery Stenting

Effects of Carotid Endarterectomy or Stenting on Blood Pressure in the International Carotid Stenting Study (ICSS)

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