Blood Pressure Variability Can Predict Carotid Sinus Reaction After Carotid Stenting

BACKGROUND Carotid stenting has become an important treatment for carotid disease. Carotid sinus reaction (CSR), a complication which is not uncommon and affects the outcome of carotid stenting. We investigated the predictors of CSR, including blood pressure variability and heart rate variability (BPV and HRV, respectively). METHODS We enrolled patients who underwent carotid stenting. CSR was defined as any episode of systolic blood pressure (SBP) <90 mm Hg or heart rate (HR) <60 beats/min after stent deployment or balloon inflation. BPV and HRV were measured before stent insertion and were represented by coefficient of variation (CoV) and SD. Multivariable logistic regression was performed to predict CSR. RESULTS Among the 176 patients, 61 (34.7%) patients showed CSR. Blood pressure and HR were measured 14 times before carotid stenting on average. The risk of CSR was independently associated with the use of longer stent (odds ratio: 1.08, 95% confidence interval: 1.00-1.16, P = 0.042) and increased SBP SD (1.07 [1.00-1.14], P = 0.048). Moreover, when the SBP parameter changed to SBP CoV, total stent length (1.08 [1.00-1.16], P = 0.042) and SBP CoV (1.12 [1.02-1.23], P = 0.023) were associated with the occurrence of CSR. CONCLUSIONS The use of a longer stent and increased SBP variability before carotid stent insertion were associated with the risk of CSR after carotid stenting. Underlying autonomic dysregulation may increase the risk of CSR during carotid stenting. SBP variability before carotid stenting might be considered a predictor of CSR.