Title:
Carotid Artery Stenting-Induced Hemodynamic Instability
Languages of Item:
English
Abstract:
Purpose: To present a systematic review and meta-analysis investigating
the incidence of carotid artery stenting (CAS) induced hemodynamic
instability (HI) and to explore differences in periprocedural risk among
patients with and without CAS-associated HI.
Methods: Multiple electronic health databases were searched for all
articles published between January 2000 and December 2011 describing
CAS-associated hemodynamic instability. Twenty-seven studies with a
total of 4204 patients were analyzed, placing emphasis on the HI
incidence and its correlation with postprocedure morbidity and
mortality. A meta-regression analysis was conducted to investigate the
role of potential meaningful modifiers upon HI.
Results: The meta-analysis for overall HI rate showed a pooled
proportion of 39.4%. The pooled estimate for hypotension was 12.1%,
12.2% for bradycardia, and 12.5% for both hypotension and bradycardia.
Persistent HI was found to occur in a pooled rate of 19.2%. No
statistically significant differences were found between patients with
and without HI after CAS with respect to death, stroke, transient
ischemic attack (TIA), or major adverse events. The meta-regression
analysis revealed statistically significant associations of mean age
with HI, of <= 10-mm distance between the carotid bifurcation and the
site of minimum lumen diameter with bradycardia, and of prior
ipsilateral CEA with persistent HI.
Conclusion: CAS-induced HI occurs in a considerable percentage of
patients without increasing the perioperative risk. However, applying
the appropriate prophylactic measures and strictly monitoring blood
pressure and heart rate during the procedure and immediately after
should be encouraged for early recognition and correction of these
hemodynannic disturbances. J Endovasc Ther. 2013;20:48-60
Authors:
Mylonas, Spyridon N.
Moulakakis, Konstantinos G.
Antonopoulos,
Constantinos N.
Kakisis, John D.
Liapis, Christos D.
Journal:
Journal of Endovascular Therapy
Publisher:
SAGE Publications Inc.
Keywords:
baroreceptors; bradycardia; carotid stenting; hypotension;
bradyarrhythmia; systematic review; meta-analysis; mortality; morbidity;
stroke; complications
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