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CORONADO, CALIF. – Periprocedural hemodynamic instability, which occurs frequently during carotid artery stenting, may increase the risk of transient ischemic attack, a single-center study showed.
“In carotid artery angioplasty and stenting, manipulation of the carotid sinus baroreceptor can lead to decreased sympathetic vascular tone, increased parasympathetic efferent signals, and a resultant bradycardia and hypotension,” Dr. Tiffany Y. Wu said at the annual meeting of the Western Vascular Society.
According to published reports in the medical literature, the incidence of hemodynamic instability (HI) following carotid artery stenting (CAS) has been observed in 46%-84% of cases. Several studies have also shown that different factors may be associated with the development of HI, according to Dr. Wu of the department of surgery at Huntington Hospital, Pasadena, Calif. “For example, gender, age, tobacco use, and diabetes have all been implicated in being associated with an increased incidence of HI,” she said. “However, the impact of HI on major adverse events is still highly controversial. Thus, it was the purpose of our study to determine the predictors and consequences of hemodynamic instability following CAS.”
She and her associates evaluated consecutive patients who underwent CAS at Huntington Hospital between 2005 and 2013. They examined preoperative risk factors, periprocedural hemodynamic status, and the incidence of major adverse events including stroke, transient ischemic attack, myocardial infarction, and death. The researchers used chi-square analysis to determine the role of periprocedural factors in predicting the risk of HI and to determine if patients experiencing HI were more likely to suffer major adverse events, compared with those who did not.
In all, 199 CAS procedures were performed in 191 patients. More than half (61%) were men, 87% had hypertension, 49% were smokers, 48% had coronary artery disease, 38% had diabetes, 56% were asymptomatic, 24% had experienced a previous TIA, 20% had experienced a previous stroke, 41% were on beta blockers, and 91% received periprocedural atropine.
Hemodynamic instability was classified as hypertension, hypotension, bradycardia, a systolic BP drop of greater than 30 mm Hg, a heart rate drop of more than 20 beats per minute, HI lasting less than 1 hour (transient), or HI lasting more than 1 hour (prolonged).
Dr. Wu reported that 130 cases of HI occurred (65%). Among these, 10% experienced hypotension, 17% experienced bradycardia, and 2.5% experienced a heart rate drop greater than 20 beats per minute. “We also found a low incidence of ICU admission: Only 5.5% of our patients were admitted to the ICU with hemodynamic instability, less than half of whom required the use of vasopressors,” she said. The incidence of major and minor stroke was 1% and 2.5%, respectively, and the incidence of TIA was 2.5%. No MIs or deaths occurred.
The researchers found that age of at least 80 years and female sex were associated with an increased incidence of HI. Previous neck radiation and contralateral occlusion were “somewhat protective against HI,” she noted. “When looking at HI and major adverse events, we found that only prolonged HI was associated with an increased incidence of TIA. However, there was no statistically significant correlation found between HI and stroke.”
Dr. Wu reported having no financial disclosures.
On Twitter @dougbrunk
CORONADO, CALIF. – Periprocedural hemodynamic instability, which occurs frequently during carotid artery stenting, may increase the risk of transient ischemic attack, a single-center study showed.
“In carotid artery angioplasty and stenting, manipulation of the carotid sinus baroreceptor can lead to decreased sympathetic vascular tone, increased parasympathetic efferent signals, and a resultant bradycardia and hypotension,” Dr. Tiffany Y. Wu said at the annual meeting of the Western Vascular Society.
According to published reports in the medical literature, the incidence of hemodynamic instability (HI) following carotid artery stenting (CAS) has been observed in 46%-84% of cases. Several studies have also shown that different factors may be associated with the development of HI, according to Dr. Wu of the department of surgery at Huntington Hospital, Pasadena, Calif. “For example, gender, age, tobacco use, and diabetes have all been implicated in being associated with an increased incidence of HI,” she said. “However, the impact of HI on major adverse events is still highly controversial. Thus, it was the purpose of our study to determine the predictors and consequences of hemodynamic instability following CAS.”
She and her associates evaluated consecutive patients who underwent CAS at Huntington Hospital between 2005 and 2013. They examined preoperative risk factors, periprocedural hemodynamic status, and the incidence of major adverse events including stroke, transient ischemic attack, myocardial infarction, and death. The researchers used chi-square analysis to determine the role of periprocedural factors in predicting the risk of HI and to determine if patients experiencing HI were more likely to suffer major adverse events, compared with those who did not.
In all, 199 CAS procedures were performed in 191 patients. More than half (61%) were men, 87% had hypertension, 49% were smokers, 48% had coronary artery disease, 38% had diabetes, 56% were asymptomatic, 24% had experienced a previous TIA, 20% had experienced a previous stroke, 41% were on beta blockers, and 91% received periprocedural atropine.
Hemodynamic instability was classified as hypertension, hypotension, bradycardia, a systolic BP drop of greater than 30 mm Hg, a heart rate drop of more than 20 beats per minute, HI lasting less than 1 hour (transient), or HI lasting more than 1 hour (prolonged).
Dr. Wu reported that 130 cases of HI occurred (65%). Among these, 10% experienced hypotension, 17% experienced bradycardia, and 2.5% experienced a heart rate drop greater than 20 beats per minute. “We also found a low incidence of ICU admission: Only 5.5% of our patients were admitted to the ICU with hemodynamic instability, less than half of whom required the use of vasopressors,” she said. The incidence of major and minor stroke was 1% and 2.5%, respectively, and the incidence of TIA was 2.5%. No MIs or deaths occurred.
The researchers found that age of at least 80 years and female sex were associated with an increased incidence of HI. Previous neck radiation and contralateral occlusion were “somewhat protective against HI,” she noted. “When looking at HI and major adverse events, we found that only prolonged HI was associated with an increased incidence of TIA. However, there was no statistically significant correlation found between HI and stroke.”
Dr. Wu reported having no financial disclosures.
On Twitter @dougbrunk
CORONADO, CALIF. – Periprocedural hemodynamic instability, which occurs frequently during carotid artery stenting, may increase the risk of transient ischemic attack, a single-center study showed.
“In carotid artery angioplasty and stenting, manipulation of the carotid sinus baroreceptor can lead to decreased sympathetic vascular tone, increased parasympathetic efferent signals, and a resultant bradycardia and hypotension,” Dr. Tiffany Y. Wu said at the annual meeting of the Western Vascular Society.
According to published reports in the medical literature, the incidence of hemodynamic instability (HI) following carotid artery stenting (CAS) has been observed in 46%-84% of cases. Several studies have also shown that different factors may be associated with the development of HI, according to Dr. Wu of the department of surgery at Huntington Hospital, Pasadena, Calif. “For example, gender, age, tobacco use, and diabetes have all been implicated in being associated with an increased incidence of HI,” she said. “However, the impact of HI on major adverse events is still highly controversial. Thus, it was the purpose of our study to determine the predictors and consequences of hemodynamic instability following CAS.”
She and her associates evaluated consecutive patients who underwent CAS at Huntington Hospital between 2005 and 2013. They examined preoperative risk factors, periprocedural hemodynamic status, and the incidence of major adverse events including stroke, transient ischemic attack, myocardial infarction, and death. The researchers used chi-square analysis to determine the role of periprocedural factors in predicting the risk of HI and to determine if patients experiencing HI were more likely to suffer major adverse events, compared with those who did not.
In all, 199 CAS procedures were performed in 191 patients. More than half (61%) were men, 87% had hypertension, 49% were smokers, 48% had coronary artery disease, 38% had diabetes, 56% were asymptomatic, 24% had experienced a previous TIA, 20% had experienced a previous stroke, 41% were on beta blockers, and 91% received periprocedural atropine.
Hemodynamic instability was classified as hypertension, hypotension, bradycardia, a systolic BP drop of greater than 30 mm Hg, a heart rate drop of more than 20 beats per minute, HI lasting less than 1 hour (transient), or HI lasting more than 1 hour (prolonged).
Dr. Wu reported that 130 cases of HI occurred (65%). Among these, 10% experienced hypotension, 17% experienced bradycardia, and 2.5% experienced a heart rate drop greater than 20 beats per minute. “We also found a low incidence of ICU admission: Only 5.5% of our patients were admitted to the ICU with hemodynamic instability, less than half of whom required the use of vasopressors,” she said. The incidence of major and minor stroke was 1% and 2.5%, respectively, and the incidence of TIA was 2.5%. No MIs or deaths occurred.
The researchers found that age of at least 80 years and female sex were associated with an increased incidence of HI. Previous neck radiation and contralateral occlusion were “somewhat protective against HI,” she noted. “When looking at HI and major adverse events, we found that only prolonged HI was associated with an increased incidence of TIA. However, there was no statistically significant correlation found between HI and stroke.”
Dr. Wu reported having no financial disclosures.
On Twitter @dougbrunk
AT THE WESTERN VASCULAR SOCIETY ANNUAL MEETING
Key clinical point: Prolonged hemodynamic instability after carotid artery stenting is associated with increased incidence of TIA, but not MI or death.
Major finding: Age of at least 80 years and female sex were associated with an increased incidence of post-CAS HI. The only significant adverse effect was TIA in patients with prolonged HI.
Data source: A review of 199 CAS procedures performed in 191 consecutive patients at Pasadena, Calif.–based Huntington Hospital between 2005 and 2013.
Disclosures: Dr. Wu reporting having no financial disclosures.
