Role of stent selection in the incidence of persisting hemodynamic depression after carotid artery stenting

J Endovasc Ther. 2015 Feb;22(1):122-9. doi: 10.1177/1526602814566404.

Abstract

Purpose: To investigate the possible role of stent selection and procedure-related vessel diameter changes in the development of persisting hemodynamic depression (PHD) and to demonstrate the effectiveness and safety of permanent pacemaker implantation in patients with refractory PHD.

Methods: Data from 584 procedures performed in 542 patients (398 men; mean age 67.3 years) between 2008 and 2011 using Wallstent, Precise, and Xact stents in a nonrandomized fashion were analyzed retrospectively. Cardiovascular risk factors and lesion, stent, and balloon characteristics were collected, and the pre- and postprocedure diameters of the common carotid artery (CCA) and internal carotid artery were measured. PHD was defined as any episode of hypotension (systolic blood pressure <90 mm Hg) and/or bradycardia (heart rate <60/min) lasting >6 hours. Risk factors for PHD were sought using logistic regression analyses; the results are presented as the odds ratio (OR) and 95% confidence interval (CI).

Results: The incidence of PHD was 37.0% (216/584). Refractory PHD was encountered in 9 patients; among these, 6 were successfully treated with pacemaker implantation. A history of prior ipsilateral carotid endarterectomy (OR 0.44, 95% CI 0.22 to 0.87, p=0.019) and the presence of a contralateral high-grade stenosis (OR 0.12, 95% CI 0.02 to 0.95, p=0.045) were independent protective factors, while calcification (OR 1.5, 95% CI 1.03 to 2.18, p=0.034), involvement of the carotid bulb (OR 2.56, 95% 1.62 to 4.03, p<0.001), and implantation of a nitinol stent (adjusted OR 1.62, 95% CI 1.12 to 2.34, p=0.011) were independent risk factors for developing PHD after carotid artery stenting. The ratio of the post-/preprocedure CCA diameter (p=0.002), the stent to CCA diameter ratio (p=0.009), and the presence of residual stenosis (p=0.009) were significantly higher in the PHD group.

Conclusion: Stent selection and procedure-related changes in vessel diameter may have an influence on the development of PHD. Permanent pacemaker implantation is an effective treatment option in patients with refractory PHD.

Keywords: baroreceptor; bradycardia; carotid artery; carotid artery stenting; hypotension; nitinol stent; pacemaker; self-expanding stent.

MeSH terms

  • Aged
  • Alloys
  • Angioplasty, Balloon* / adverse effects
  • Body Mass Index
  • Bradycardia / etiology
  • Carotid Artery, Common / pathology*
  • Carotid Artery, Internal / pathology
  • Carotid Stenosis / epidemiology
  • Carotid Stenosis / pathology*
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / therapy*
  • Female
  • Hemodynamics*
  • Humans
  • Hypertension / etiology
  • Incidence
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / administration & dosage
  • Postoperative Care
  • Preoperative Care
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stents* / adverse effects
  • Treatment Outcome

Substances

  • Alloys
  • Platelet Aggregation Inhibitors
  • nitinol