The Prevalence and Factors Contributing to Hemodynamic Depression in Patients Undergoing Carotid Angioplasty and Stenting.

Abstract Introduction/background: Hemodynamic depression including bradycardia and hypotension are among the most common complications of carotid angioplasty and stenting. Methods and Material: A prospective, cross-sectional study was conducted at Shiraz University of Medical Sciences in southern Iran from 2011 to 2013. Consecutive patients underging carotid angioplasty and stenting were included. Demographic data, atherosclerotic risk factors, pre-procedural blood pressure, site of stenosis , degree of stenosis, and  data regarding technical factors were recorded. Hemodynamic depression was defined as a systolic blood pressure less than 90 mmHg and/or heart rate   less than 50 beat/min. Results: 170   patients (67% male, mean  age: 71+9.8,  55.9%  right side, 82.9%  symptomatic ) were recruited. Mean degree of stenosis was 79.4% in operated side and 40.7% in non-operated side.  Predilation, post dilation, or both were conducted in 18(10.5%), 141(83%), 11 (6.5%) patients respectively.   Thirteen (7.6%), 41(24%), and 12(7%) of patients developed post-procedural bradycardia, hypotension or both respectively. Two patients had a stroke after CAS and peri-procedural mortality was 0%.  Hemodynamic depression after CAS had a significant association with pre-procedure blood pressure and  the use of an open cell stent design,  but not with atherosclerotic risk factors, site and/or degree of stenosis, predialtion, or postdilation.   Hemodynamic   depression significantly increased hospital stay too. Conclusion: Pre-procedural hydration and close-cell stents may decrease the risk of post-stenting hemodynamic depression.