Abstract
We evaluated predictive factors for prolonged hypotension after carotid artery stenting by retrospectively analyzing 88 lesions of 77 consecutive patients (mean age: 69.9±8.0 years). Easy Wall stent was applied in 14 lesions, SMART stent in 35, Protégé stent in 15, Aurora stent in 11 and Precise stent in 13. We investigated correlations between the incidence of prolonged (≧3 hours) hypotension below 90 mmHg and clinical characteristics, angiographic findings and kind of deployed stents. Postprocedural hypotension occurred in 44 lesions (50%), and medical treatment (intravenous administration of catecholamines) was required in 21 lesions (23.9%). Although there was no permanent neurological deficits related with postprocedural hypotension, transient neurological deficits including consciousness disturbance were found in 5 patients. Predictive factors of prolonged hypotension were assessed by univariate and multivariate analyses. Among angiographic characteristics, calcifications at the carotid bifurcation (present vs. absent: p=0.004) were statistically significant on multivariate analysis. Although other variables including age, gender, side of lesion and degree of stenosis were not associated with postprocedural hypotension after carotid stenting, SMART (eR) stent and Protégé stent were accompanied with frequent occurrence of prolonged hypotension in this study.
Among angiographic variables, the presence of calcification at the carotid bifurcation can be used to identify patients at risk for postprocedural hypotension after carotid stenting. Furthermore, such identification may help us prevent a perioperative complication of CAS for high-risk patients.
