Frequency and determinants of postprocedural hemodynamic instability aftercarotid angioplasty and stenting

Background and Purpose-Hemodynamic instability can occur acutely after caro tid angioplasty and stent placement (CAS). We performed this study to deter mine the frequency of hemodynamic instability in a series of patients who u nderwent CAS and to analyze factors associated with development of postproc edural hemodynamic events. Methods-We reviewed medical records and angiograms in a series of 51 patien ts (mean age 68.3 +/- 8.9 years) who underwent CAS for symptomatic (n = 29) or asymptomatic (n = 22) carotid artery stenosis. Any episodes of hypotens ion (systolic blood pressure <90 mm Hg), hypertension (systolic blood press ure >160 mm Hg), or bradycardia (heart rate <60 bpm) that occurred in the a cute postprocedural period were recorded. The effect of demographic, clinic al, intraprocedural, and angiographic factors on subsequent development of hemodynamic instability was analyzed by logistic regression. Results-The frequency of postprocedural hemodynamic complications in our pa tient series was as follows: hypotension, 22.4%; hypertension, 38.8%; and b radycardia, 27.5%. Intraprocedural hypotension (odds ratio [OR] 14.6, P = 0 .024) and history of myocardial infarction (OR 14.1, P = 0.04) independentl y predicted postprocedural hypotension. Postprocedural hypertension was pre dicted by intraprocedural hypertension (OR 7.6, P = 0.01) and previous ipsi lateral carotid endarterectomy (OR 7.6, P = 0.02). Postprocedural bradycard ia was associated with intraprocedural hypotension (OR 74, P = 0.001) and i ntraprocedural bradycardia (OR 12, P = 0.008). All events had resolved at t he conclusion of the intensive care unit monitoring period (mean 25.7 hours , range 18 to 43 hours). Conclusions-Postprocedural hemodynamic instability is frequent after CAS an d supports the need for monitoring in settings suited to expeditious manage ment of cardiovascular emergencies. Patients who have evidence of hemodynam ic instability during the procedure are at highest risk.