Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting

OBJECTIVES We sought to determine the frequency, predictors, and consequences of hemodynamic depression (HD) after carotid artery stenting (CAS). BACKGROUND Hemodynamic depression has been reported after carotid artery stenting CAS and carotid endarterectomy (CEA). METHODS We retrospectively analyzed data on 500 consecutive CAS procedures performed over a 5-year period. Hemodynamic depression was defined as penprocedural hypotension (systolic blood pressure < 90 mm Hg) or bradycardia (heart rate < 60 beats/s). Univariate and multivariate binary logistic regression models were used to determine the predictors and consequences of HD and persistent HD. RESULTS The mean age of the patients was 70.5 +/- 10 years, and 69% were men. Hemodynamic depression occurred during 210 procedures (42%), whereas persistent HD developed in 84 procedures (17%). Features that independently predicted HD included lesions involving the carotid bulb (odds ratio [OR] 2.18 [range 1.46 to 3.26], p < 0.0001) or the presence of a calcified plaque (OR 1.89 [range 1.25 to 2.84], p < 0.002). Prior ipsilateral CEA was associated with reduced risk of HD (OR 0.35 [range 0.20 to 0.60], p < 0.0001). Patients who developed persistent HD were at a significantly increased risk of a periprocedural major adverse clinical event (OR 3.05 [range 1.35 to 5.23], p < 0.02) or stroke (OR 3.34 [range 1.13 to 9.90], p < 0.03). CONCLUSIONS Hemodynamic depression is common after CAS, particularly in patients with a calcified plaque in the carotid bulb, but is easily treated with conventional methods. Patients who develop persistent HD are at an increased risk of periprocedural major adverse clinical events and stroke.