Postprocedural hypotension after carotid artery stent placement: Predictors and short- and long-term clinical outcomes

PURPOSE: To describe the predictors of persistent hypotension after carotid artery stent (CAS) placement and define the clinical outcome of patients w ith this hemodynamic disturbance. MATERIALS AND METHODS: One hundred forty CAS procedures were performed in 1 33 consecutive patients. Post-GAS hypotension-defined as a greater than 40 mm Hg decrease in arterial pressure without evidence of hypovolemia, with a systolic pressure lower than 90 mm Hg at the end of CAS and lasting at lea st 1 hour-was observed in 25 patients (group 1);108 patients did not have h ypotension (group 2). RESULTS: Post-GAS hypotension developed in 33.9% of cases after balloonexpa ndable stent placement versus in 13.6% of cases after self-expanding stent placement (P =.04). in-hospital minor ipsilateral strokes occurred in 16% o f cases in group 1 versus in 3% of cases in group 2 (P =.03). There was one (0.9%) major stroke (transient) and three (2.6%) transient ischemic attack s, all of which occurred in group 2 (not significant vs group 1 for both co nditions). At 10 months +/- 4 (SD) of follow-up, there was greater total mo rtality in group 1 than in group 2 (20% vs 4%, P =.02), whereas neurologic events did not differ significantly between the groups. CONCLUSION: Hypotension due to carotid sinus stimulation is frequent after CAS with balloon-expandable stents. This phenomenon correlates with increas ed in-hospital complications and long-term risk of death.