ABSTRACT
Objective: To investigate the acute effect of carotid artery stenting (CAS) on hemodynamics. Methods: We retrospectively analyzed 170 consecutive patients who received CAS in our hospital from 2014-09 to 2015-09. The acute effects of proximal internal CAS on blood pressure (BP) and heart rate (HR) were studied, the patients were followed-up for a month to observe the relationship between CAS and peri-operative adverse events occurrence. Results: ① Compared with pre-operative condition, the all day mean systolic blood pressure (SBP) from (126.6±15.1, 93-175) mmHg decreased to (117.7±13.7, 87-158) mmHg, P<0.01, all day mean DBP from (72.8±11.5, 49-100) mmHg decreased to (67.3±10.3, 48-90) mmHg, P<0.01, and all day HR from (66.3±6.8, 49-84) bpm decreased to (62.6±7.2, 49-88) bpm, P<0.01. ② The incidence of hemodynamic instability (HI) was 51.8％ (88/170) and the occurrence rates of thypertension, hypotension and bradycardia were 3.5％ (6/170), 39.4 ％ (67/170) and 22.4％ (38/170) respectively. Multivariate regression analysis showed that HI was closely related to gender, history of hypertension, bilateral CAS and carotid bifurcation lesions. Upon HI onset, BP and HR could be restored to normal via intravenous infusion of vasoactive drugs and 6 (3.5％) patients having the medication time more than 24 hours. ③ Peri-operative adverse events happened in 8 (4.7％) patients including 4 transient ischemic attack, 2 minor stroke and 2 major stroke (1 patient died). The ratio of adverse events was 2.4％ (2/82) in Non-HI group and 6.8％ (6/88) in HI group, P=0.32. In HI group, the incidences of hypertension, hypotension, bradycardia and hypotension combining bradycardia were 16.7％ (1/6), 6.8％ (3/44), 0％ (0/15) and 8.7％ (2/23) respectively, compared with the overall patients' group, P=0.669, P=0.723, P=0.793 and P=0.658 respectively. Conclusion: HI incidence was relatively high in peri-operative period of CAS; gender, history of hypertension, bilateral CAS and carotid bifurcation lesions were the independent predictors for CAS occurrence. It is important to reasonably use vasoactive drugs in time for preventing and reducing HI related adverse events.
ABSTRACT
Objective: To investigate the acute effect of carotid artery stenting (CAS) on hemodynamics. Methods: We retrospectively analyzed 170 consecutive patients who received CAS in our hospital from 2014-09 to 2015-09. The acute effects of proximal internal CAS on blood pressure (BP) and heart rate (HR) were studied, the patients were followed-up for a month to observe the relationship between CAS and peri-operative adverse events occurrence. Results: ① Compared with pre-operative condition, the all day mean systolic blood pressure (SBP) from (126.6±15.1, 93-175) mmHg decreased to (117.7±13.7, 87-158) mmHg, P<0.01, all day mean DBP from (72.8±11.5, 49-100) mmHg decreased to (67.3±10.3, 48-90) mmHg, P<0.01, and all day HR from (66.3±6.8, 49-84) bpm decreased to (62.6±7.2, 49-88) bpm, P<0.01. ② The incidence of hemodynamic instability (HI) was 51.8％ (88/170) and the occurrence rates of thypertension, hypotension and bradycardia were 3.5％ (6/170), 39.4 ％ (67/170) and 22.4％ (38/170) respectively. Multivariate regression analysis showed that HI was closely related to gender, history of hypertension, bilateral CAS and carotid bifurcation lesions. Upon HI onset, BP and HR could be restored to normal via intravenous infusion of vasoactive drugs and 6 (3.5％) patients having the medication time more than 24 hours. ③ Peri-operative adverse events happened in 8 (4.7％) patients including 4 transient ischemic attack, 2 minor stroke and 2 major stroke (1 patient died). The ratio of adverse events was 2.4％ (2/82) in Non-HI group and 6.8％ (6/88) in HI group, P=0.32. In HI group, the incidences of hypertension, hypotension, bradycardia and hypotension combining bradycardia were 16.7％ (1/6), 6.8％ (3/44), 0％ (0/15) and 8.7％ (2/23) respectively, compared with the overall patients' group, P=0.669, P=0.723, P=0.793 and P=0.658 respectively. Conclusion: HI incidence was relatively high in peri-operative period of CAS; gender, history of hypertension, bilateral CAS and carotid bifurcation lesions were the independent predictors for CAS occurrence. It is important to reasonably use vasoactive drugs in time for preventing and reducing HI related adverse events.