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Vascular and Interventional Radiology |
1 From the Division of Cardiology and the Departments of Neuroradiology and Neurology, Washington Hospital Center, Washington, DC. Received April 7, 1999; revision requested June 1; final revision received August 17; accepted August 26. Supported in part by an educational grant from the Cardiovascular Research Foundation, New York, NY. Address correspondence to M.B.L., Cardiovascular Research Foundation, 55 E 59th St, 6th Floor, New York, NY 10022 (e-mail: mbleonmd@compuserve.com).
PURPOSE: To describe the predictors of persistent hypotension after carotid artery stent (CAS) placement and define the clinical outcome of patients with this hemodynamic disturbance.
MATERIALS AND METHODS: One hundred forty CAS procedures were performed in 133 consecutive patients. Post-CAS hypotension—defined as a greater than 40 mm Hg decrease in arterial pressure without evidence of hypovolemia, with a systolic pressure lower than 90 mm Hg at the end of CAS and lasting at least 1 hour—was observed in 25 patients (group 1); 108 patients did not have hypotension (group 2).
RESULTS: Post-CAS hypotension developed in 33.9% of cases after balloon-expandable stent placement versus in 13.6% of cases after self-expanding stent placement (P = .04). In-hospital minor ipsilateral strokes occurred in 16% of cases in group 1 versus in 3% of cases in group 2 (P = .03). There was one (0.9%) major stroke (transient) and three (2.6%) transient ischemic attacks, all of which occurred in group 2 (not significant vs group 1 for both conditions). At 10 months ± 4 (SD) of follow-up, there was greater total mortality in group 1 than in group 2 (20% vs 4%, P = .02), whereas neurologic events did not differ significantly between the groups.
CONCLUSION: Hypotension due to carotid sinus stimulation is frequent after CAS with balloon-expandable stents. This phenomenon correlates with increased in-hospital complications and long-term risk of death.
Index terms: Arteries, transluminal angioplasty, 172.1286, 908.1286 • Carotid arteries, angiography, 172.1248, 908.122 • Carotid arteries, flow dynamics, 172.76, 908.76 • Carotid arteries, interventional procedures, 172.1286, 908.1286 • Carotid arteries, US, 171.1298, 172.1298, 908.1298
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