Analysis of factors associated with hemodynamic instability during carotid artery angioplasty and stenting

Introduction. Systemic hypotension has been observed for up to 72 hours in response to stimulation of the carotid baroreceptor by carotid angioplasty and stenting (CAS). This study sought to identify risk factors and cardiac outcomes for post procedural hypotension after carotid artery angioplasty and stenting. Methods. Between 2003 and 2005, 143 patients (87 men, mean age 75) with high-grade carotid artery stenosis (mean, 87.3%) were treated with CAS. Atropine and appropriate intravenous crystalloid solution were administered during CAS. Hypotension was treated with vasopressors (dopamine, phenylephrine or norepinphrine). Patients were stratified into three groups based on hypotension (systolic blood pressure < 90) requiring vasopressors for 0 hours ( no vasopressors ), less than or equal to 24 hours (short duration) and > 24 hours (prolonged duration). Risk factors for hypotension requiring vasopressors were analyzed by univariate and multivariate logistic regression analysis. Results. Post procedural (not including intraprocedure vasopressors) hypotension requiring vasopressor treatment was seen in 16/143 (11%) of patients, with 6/143 (4%) requiring vasopressor support for more than 24 hours. Mean duration of vasopressor administration was 23 hours (range 6\'d072 hours). By univariate analysis, a history of a previous MI (p ≤ .02), or use of the PercuSurge occlusion balloon (p ≤ .05) were both associated with increased incidence of short duration vasopressors (less than or equal to 24 hrs) use, while female sex (p ≤ .03) and age > 80 (p ≤ .02) were associated with prolonged vasopressor requirement (> 24 hours). On multivariate analysis, a history of MI (OR 4.2, 95% CI 1.1\'d016.3, p ≤ .04) remained an independent predictor of short-duration vasopressors, and female sex (OR 10.9, 95% CI 1.2\'d0100.4, p ≤ .04) and age > 80 years old (OR 13.8, 95% CI 1.5\'d0127.2, p ≤ .02) remained predictors of prolonged vasopressor use. The incidence of periprocedural MI, arrhythmias or cardiac heart failure did not differ between those patients who did not receive vasopressors (5/127) and those that received vasopressors for a short duration (less than or equal to 24 hours ≤ 1/10, p ≤ NS) or prolonged duration (> 24 hours ≤ 0/6, p ≤ NS). These findings suggest that post-operative hypotension requiring vasopressors is not caused by and does not induce peri-procedural cardiac complications. Conclusion. Prolonged hypotension requiring vasopressor support is rare after CAS, with higher incidences in older females. Prolonged hypotension requiring vasopressors is not associated with an increased incidence of periprocedural cardiac complications.