Postoperative hypotension after carotid angioplasty and stenting: Report of three cases

OBJECTIVE AND IMPORTANCE: Hemodynamic instability after carotid angioplasty and stenting is not well recognized. We report three patients who develope d sustained hypotension in the postoperative period after successful caroti d angioplasty and stent placement for internal carotid artery stenosis in t he carotid sinus region. CLINICAL PRESENTATION: In two patients, hypotension was initially induced b y inflation of the angioplasty balloon. The third patient developed hypoten sion after completion of the procedure. In all cases, the hypotension persi sted for 18 to 33 hours after the procedure. During the postoperative perio d, two of these patients also developed sinus bradycardia, which, in one pa tient, was further complicated by a third-degree atrioventricular block. INTERVENTION: The hypotension was successfully treated by intravenous vasop ressors or inotropic agents. No permanent neurological or cardiac sequelae were observed. CONCLUSION: Sustained hypotension with or without bradycardia may develop a fter carotid angioplasty and stent placement, presumably as a result of car otid sinus dysfunction. During the postoperative period, patients should be monitored in settings suited to expeditious management of cardiovascular e mergencies.