Brant W. Ullery, Derek P. Nathan, Erin H. Murphy, Grace J. Wang, Benjamin M. Jackson, Benjamin J. Herdrich, Ronald M. Fairman, Edward Y. Woo
Surgery, University of Pennsylvania, Philadelphia, PA.
OBJECTIVES: To explore the incidence, predictors, and outcomes of hemodynamic instability (HI) following carotid angioplasty and stenting (CAS).
METHODS: We retrospectively evaluated data on 257 CAS procedures performed in 245 patients from 2002-2011. The presence of periprocedural HI, including hypertension (systolic blood pressure [SBP]>160 mmHg), hypotension (SBP <90 mmHg), or bradycardia (heart rate <60 beats per minute), was recorded. Logistic regression was used to analyze the role of multiple demographic, clinical, and procedural variables.
RESULTS: Mean age was 70.9±9.9 years (66.9% male). Hemodynamic instability occurred following 84.0% (n=216) of procedures and was prolonged (duration>1 hour) in 63.0% of cases. The incidence of hypertension, hypotension, and bradycardia was 53.7%, 30.7%, and 60.3%, respectively. Previous neck intervention (CEA, CAS, dissection, radiation), intraoperative atropine or glycopyrrolate, laterality, presence of carotid symptoms, degree of stenosis, contralateral carotid occlusion, balloon diameter or length, and stent diameter or length were not predictive of HI. Lower preoperative heart rate independently predicted periprocedural HI (71.9±12.1 vs. 79.8±11.3 beats per minute; p<0.001). Chronic renal insufficiency was associated with postoperative hypertension (66.7% vs. 33.3%, p=0.035). Presence of HI was not associated with increased risk of postoperative stroke (4.6% vs. 2.4%, p=1.00), myocardial infarction (0.5% vs. 0.0%, p=1.0), or mortality (0.5% vs. 0.0%, p=1.0). However, patients with prolonged HI trended toward a higher incidence of postoperative stroke (6.6% vs. 0%, p=0.07).
CONCLUSIONS: Hemodynamic instability represents a common occurrence following CAS. While the presence of periprocedural HI alone did not portend a worse clinical outcome, prolonged HI trended toward increased incidence of postoperative stroke. Expeditious interventions to control or prevent periprocedural HI is of critical importance.
AUTHOR DISCLOSURES: R. M. Fairman, Nothing to disclose; B. J. Herdrich, Nothing to disclose; B. M. Jackson, Nothing to disclose; E. H. Murphy, Nothing to disclose; D. P. Nathan, Nothing to disclose; B. W. Ullery, Nothing to disclose; G. J. Wang, Nothing to disclose; E. Y. Woo, Nothing to disclose.
Posted April 2012