Journal of Shandong University (Health Sciences) ›› 2023, Vol. 61 ›› Issue (7): 78-82.doi: 10.6040/j.issn.1671-7554.0.2023.0067

• 临床医学 • Previous Articles    

Risk factors of severe persistent hypotension after carotid artery bifurcation stenting

QU Yongqiang, ZHAO Zeyu, WU Xingyuan, HAN Wei, DUAN Ruisheng, LI Yanbin, LI Heng   

  1. Department of Neurology, The First Affiliated Hospital of Shandong First Medical University &
    Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan 250014, Shandong, China
  • Published:2023-07-04

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Abstract: Objective To analyze the risk factors of severe persistent hypotension after carotid artery bifurcation stenting. Methods Clinical data of 177 patients(181 lesions)with carotid artery bifurcation stenosis who underwent stenting during Oct. 2014 and Apr. 2022 were retrospectively analyzed. The risk factors for postoperative severe persistent hypotension were analyzed with univariate and multivariate Logistic regression models. Results The incidence of severe persistent hypotension was 53.1%. Univariate analysis showed that large stent diameter, intraoperative use of atropine, balloon dilation diameter >5 mm, eccentric stenosis and severe stenosis were risk factors of severe persistent hypotension. Multivariate analysis indicated that intraoperative use of atropine, balloon dilation diameter >5 mm and severe stenosis were independent risk factors. Conclusions Hemodynamic impairment is a common complication after carotid artery bifurcation stenting. Intraoperative use of atropine, balloon dilation diameter > 5mm and severe stenosis are independent risk factors of severe persistent hypotension.

Key words: Carotid artery bifurcation stenosis, Stent, Hypotension, Risk factor

CLC Number: 

  • R574
[1] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国缺血性卒中和短暂性脑缺血发作二级预防指南2022[J]. 中华神经科杂志, 2022, 55(10): 1071-1110. Chinese Society of Neurology, Chinese Society of Neurology and Cerebrovascular Disease. Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2022[J]. Chinese Journal of Neurology, 2022, 55(10): 1071-1110.
[2] Gupta A, Chazen JL, Hartman M, et al. Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion: a systematic review and meta-analysis [J]. Stroke, 2012, 43(11): 2884-2891.
[3] Chaturvedi S, Bruno A, Feasby T, et al. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Carotid endarterectomy - an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology [J]. Neurology, 2005, 65(6): 794-801.
[4] 余波, 谭晋韵. 颈动脉狭窄闭塞性疾病及其外科治疗的再认识[J]. 中华普通外科杂志, 2022, 37(3): 161-164. YU Bo, TAN Jinyun.Re-recognition of carotid artery stenosis and occlusion disease and its surgical treatment[J]. Chinese Journal of General Surgery, 2022, 37(3): 161-164.
[5] Gökçal E, Niftaliyev E, Deniz Ç, et al. Prolonged hypotension after carotid artery stenting: incidence, predictors and consequences [J]. Acta Neurochir(Wien), 2017, 159(11): 2081-2087.
[6] Rubio G, Karwowski JK, DeAmorim H, et al. Predicting factors associated with postoperative hypotension following carotid artery stenting [J]. Ann Vasc Surg, 2019, 54(1): 193-199.
[7] Bogniotti LAC, Teivelis MP, Cardozo FAM, et al.Hemodynamic depression after carotid surgery: Incidence, risk factors and outcomes [J]. Clinics(Sao Paulo), 2022, 77: 100090.
[8] Kim MJ, Ha SK. Outcomes following carotid endarterectomy and carotid artery atenting in patients with carotid artery stenosis: a retrospective study from a single center in South Korea [J]. Med Sci Monit, 2023, 29: e939223. doi: 10.12659/MSM.939223.
[9] Ouyang YA, Jiang Y, Yu M, et al. Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials [J]. Clinical Interventions in Aging, 2015, 10: 1733-1742. doi:10.2147/CIA.S91721.
[10] 潘晓妍. 基于UNet深度神经网络的颈动脉分叉分割研究[D]. 杭州:浙江大学, 2019.
[11] Lian X, Lin M, Liu M, et al. Complications and predictors associated with persistent hemodynamic depression after carotid artery stenting [J]. Clin Neurol Neurosurg, 2014, 124(9): 81-84.
[12] 徐格林, 樊新颖, 殷勤, 等. 颈动脉支架置入术后发生持续性低血压的危险因素分析 [J]. 中国脑血管病杂志, 2007, 4(5): 218-222. XU Gelin, FAN Xinying, YIN Qin, et al. Analysis of the risk factors for prolonged hypotension after carotid artery stenting [J].Chinese Journal of Cerebrovascular Disease, 2007, 4(5): 218-222.
[13] Jensen SK, Eesa M, Walker A, et al. Plaque characteristics on CT angiography do not improve the ability to predict hemodynamic instability during and after carotid angioplasty and stenting [J]. Journal of Neurosurgical Anesthesiology, 2021, 33(4): 337-342.
[14] Nonaka T, Oka S, Miyata K, et al. Prediction of prolonged postprocedural hypotension after carotid artery stenting [J]. Neurosurgery, 2005, 57(3): 472-477.
[15] 韩金涛, 赵海燕, 李选, 等. 颈动脉支架成形术血流动力学损害的相关因素分析[J]. 北京大学学报(医学版), 2015, 47(5): 804-808. HAN Jintao, ZHAO Haiyan, LI Xuan, et al. Related factors of hemodynamic damage after carotid artery stenting[J]. Journal of Peking University(Health Sciences), 2015, 47(5): 804-808.
[16] Chi Q, Chen Z, Zhu L, et al. Relationship between annular calcification of plaques in the carotid sinus and perioperative hemodynamic disorder in carotid angioplasty and stenting [J]. J Stroke Cerebrovasc Dis, 2022, 31(10): 106634. doi: 10.1016/j.jstrokecerebrovasdis.2022.106634.
[17] Oshin O, Varcoe R, Wong J, et al. Multivariable analysis of patients with severe persistent postprocedural hypotension after carotid artery stenting [J]. J Endovasc Ther, 2019, 26(6): 759-767.
[18] Fujii M, Satow T, Kodama H, et al. Severe hemodynamic depression after carotid artery stenting: The problem overcome with a transvenous temporary cardiac pacemaker [J]. Surg Neurol Int, 2021, 12: 255. doi: 10.25259/SNI_244_2021.
[19] Li B, Fan W, Yang Y, et al. Peri-procedural variables and outcomes of long-period hemodynamic instability after carotid artery angioplasty and stenting [J]. Vascular, 2022, 17085381221091369. doi: 10.1177/17085381221091369.
[20] Liu J, Han J, Yang L, et al. Short-term Outcome of straight vs tapered carotid stenting for symptomatic carotid artery stenosis: a prospective study [J]. J Endovasc Ther, 2018, 25(6): 765-770.
[21] Armstrong EJ, Bricker R. Commentary: hypotension after internal carotid artery stenting: is it predictable? [J]. J Endovasc Ther, 2019, 26(6): 768-770.
[22] Noori VJ, Aranson NJ, Malas M, et al. Risk factors and impact of postoperative hypotension after carotid artery stenting in the vascular quality initiative [J]. J Vasc Surg, 2021, 73(3): 975-982.
[23] van Waes JA, van Klei WA, Wijeysundera DN, et al. Association between intraoperative hypotension and myocardial injury after vascular surgery [J]. Anesthesiology, 2016, 124(1): 35-44.
[24] Arhuidese IJ, Ottinger ME, Shukla AJ, et al. Hemodynamic events during carotid stenting are associated with significant periprocedural stroke and adverse events [J]. J Vasc Surg, 2020, 71(6): 1941-1953.
[25] Chang A, Hung HF, Hsieh FI, et al. Beneficial effects of prolonged blood pressure control after carotid artery stenting [J]. Clin Interv Aging, 2017, 12(1): 103-109.
[26] Jenab Y, Hosseini K, Abtahi-Eivary SM. Treatment via oral midodrine in a patient with prolonged hypotension following carotid artery stenting: a case report [J]. J Med Case Rep, 2022, 16(1): 67. doi: 10.1186/s13256-022-03270-5.
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