Acute hemodynamic changes during carotid artery stenting.

Journal Article

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 < or =60 beats/min and hypotension as systolic BP < or =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.

Full Text

Duke Authors

Cited Authors

  • Mendelsohn, FO; Weissman, NJ; Lederman, RJ; Crowley, JJ; Gray, JL; Phillips, HR; Alberts, MJ; McCann, RL; Smith, TP; Stack, RS

Published Date

  • November 1, 1998

Published In

Volume / Issue

  • 82 / 9

Start / End Page

  • 1077 - 1081

PubMed ID

  • 9817485

International Standard Serial Number (ISSN)

  • 0002-9149

Language

  • eng

Conference Location

  • United States