The Prevalence and Factors Contributing to Hemodynamic Depression in Patients Undergoing Carotid Angioplasty and Stenting

Abstract

Background—Hemodynamic depression, including bradycardia and hypotension, is among the most
common complications of carotid angioplasty and stenting.
Methods and Material—A prospective, cross-sectional study was conducted at Shiraz University of
Medical Sciences in southern Iran from 2011 to 2013. Consecutive patients undergoing carotid angioplasty
and stenting were included. Demographic data, atherosclerotic risk factors, preprocedural blood pressure,
the site of stenosis, the degree of stenosis, and data regarding technical factors were recorded. Hemodynamic depression was defined as a systolic blood pressure less than 90 mmHg and/or heart rate less than 50
beat/min.
Results—About 170 patients (67% male, mean age: 71+9.8, 55.9% right side, 82.9% symptomatic) were
recruited. Mean degree of stenosis was 79.4% in operated side and 40.7% in nonoperated side. Predilation,
postdilation, or both were conducted in 18(10.5%), 141(83%), 11(6.5%) patients respectively. Thirteen
(7.6%), 41(24%), and 12(7%) of patients developed postprocedural bradycardia, hypotension or both,
respectively. Two patients had a stroke after CAS and periprocedural mortality was 0%. Hemodynamic
depression after CAS had a significant association with preprocedure blood pressure and the use of an open
cell stent design, but not with atherosclerotic risk factors, site and/or degree of stenosis, predilation, or postdilation. Hemodynamic depression significantly increased hospital stay too.
Conclusion—Preprocedural hydration and close-cell stents may decrease the risk of poststenting hemodynamic depression.