Hypotension and Bradycardia after Elective Carotid Stenting: Frequency and Risk Factors

2003 ◽  
Vol 10 (5) ◽  
pp. 851-859 ◽  
Author(s):  
Wolfgang Mlekusch ◽  
Martin Schillinger ◽  
Schila Sabeti ◽  
Tassilo Nachtmann ◽  
Wilfried Lang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Stenting ◽  
Hemodynamic Instability ◽  
Neurological Complications ◽  
Severe Hypotension ◽  
Artery Disease

Purpose: To investigate the frequency of and risk factors for hypotension and bradycardia in response to elective carotid stenting and their association with neurological complications. Methods: A retrospective analysis was conducted of 471 patients (321 men; median age 72 years, interquartile range 64–77) who underwent elective carotid artery stenting without cerebral protection for high-grade (>70%) symptomatic (n = 147) or asymptomatic (n=324) internal carotid artery stenosis at a single center. Frequency and potential risk factors for severe hypotension (systolic blood pressure <80 mmHg) or bradycardia (heart rate <50 bpm) were studied. Results: Thirty-four (7%) patients had severe hypotension (n=23), bradycardia (n=2), or both (n=9) despite routine premedication with atropine and adequate fluid balance. Intravenous catecholamines (dopamine) were necessary in 8 patients with prolonged hypotension; none of the patients with bradycardia needed pacemaker support. Neurological complications (transient ischemic attack, minor stroke, major stroke, death) occurring in 33 (7%) patients were not significantly associated with hemodynamic instability (4/34 [12%] versus 29/437 [7%], p = 0.26). Age >77 years (fourth quartile; OR 6.40, 95% CI 1.80 to 22.78, p=0.004) and coronary artery disease (OR 2.81, 95% CI 1.29 to 6.14, p=0.010) were associated with an increased adjusted risk for hypotension or bradycardia. Conclusions: Hemodynamic instability due to hypotension and bradycardia in response to carotid artery stenting occurs in a relatively low proportion of patients. Elderly patients and those with coronary artery disease are at highest risk. Although the rate of neurological complications was not significantly increased in patients with hemodynamic instability, the higher frequencies of neurological complications in these patients admonish us to be careful.

Silent Coronary Artery Disease in Japanese Patients Undergoing Carotid Artery Stenting

2013 ◽  
Vol 22 (7) ◽  
pp. 1163-1168 ◽  
Author(s):  
Yukiko Enomoto ◽  
Shinichi Yoshimura ◽  
Kiyofumi Yamada ◽  
Masanori Kawasaki ◽  
Kazuhiko Nishigaki ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Japanese Patients ◽  
Silent Coronary Artery Disease ◽  
Artery Disease

Effect of Carotid Revascularization Endarterectomy Versus Stenting Trial Results on the Performance of Carotid Artery Stent Placement and Carotid Endarterectomy in the United States

Neurosurgery ◽  
2015 ◽  
Vol 77 (5) ◽  
pp. 726-732 ◽  
Author(s):  
Farhan Siddiq ◽  
Malik M. Adil ◽  
Ahmed A. Malik ◽  
Mushtaq H. Qureshi ◽  
Adnan I. Qureshi
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Renal Failure ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Neurological Complications ◽  
Carotid Revascularization ◽  
Carotid Artery Stent ◽  
Artery Disease

Abstract BACKGROUND: CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) results, published in 2010, showed no difference in the rates of composite outcome (stroke, myocardial infarction, or death) between carotid artery stent placement (CAS) and carotid endarterectomy (CEA). OBJECTIVE: To identify any changes in use and outcomes of CAS and CEA subsequent to the CREST results. METHODS: We estimated the frequency of CAS and CEA procedures in the years 2009 (pre-CREST period) and 2011 (post-CREST period), using data from the National Inpatient Sample (NIS). Demographic and clinical characteristics and in-hospital outcomes of pre- and post-CREST CAS-treated and post-CREST CEA-treated patients were compared with pre-CREST CEA-treated patients. RESULTS: A total of 225 191 patients underwent CEA or CAS in the pre- and post-CREST periods. The frequency of CAS among carotid revascularization procedures did not change after publication of the CREST results (12.3% vs 12.7%, P = .9). In the pre-CREST period, the CAS group (compared with the CEA group) had higher rates of congestive heart failure (P &lt; .001), coronary artery disease (P &lt; .001), and renal failure (P &lt; .001). The post-CREST CAS group had a higher frequency of atrial fibrillation (P = .003), congestive heart failure (P &lt; .0001), coronary artery disease (P &lt; .0001), and renal failure (P = .0001). Discharge with moderate to severe disability (P &lt; .0001) and postprocedure neurological complications (P = .005) were more frequently reported in the post-CREST CAS group. After adjusting for age, sex, and risk factors, the odds ratio (OR) for moderate to severe disability was 1.0 (95% confidence interval [CI]: 0.8-1.2) in the pre-CREST CAS group and 1.4 (95% CI: 1.1-1.7) in the post-CREST CAS group compared with the reference group. The adjusted OR for neurological complications in the pre-CREST CAS group was 1.6 (95% CI: 1.2-2.1, P = .002), and 1.5 (95% CI: 1.1-2.0, P = .01) in the post-CREST CAS group. CONCLUSION: The frequency of CAS and CEA for carotid artery stenosis has not changed after publication of the CREST. The demographics, pretreatment comorbidity profile, and in-hospital complication rates remained unchanged during the 2 time periods.

scholarly journals Coronary Artery Disease Events and Carotid Intima‐Media Thickness in Type 1 Diabetes in the DCCT/EDIC Cohort

2021 ◽  
Author(s):  
Joseph F. Polak ◽  
Jye‐Yu C. Backlund ◽  
Matt Budoff ◽  
Philip Raskin ◽  
Ionut Bebu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Type 1 Diabetes ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Artery Disease

Background Carotid artery intima‐media thickness (IMT) is associated with the risk of subsequent cardiovascular events in the general population. This association has not been established in type 1 diabetes. Methods and Results We studied if carotid IMT is associated with the risk of a first coronary artery disease event in participants with type 1 diabetes in the EDIC (Epidemiology of Diabetes Interventions and Complications) study, the long‐term observational follow‐up of the DCCT (Diabetes Control and Complications Trial). Between 1994 and 1996, common carotid artery and internal carotid artery IMT were measured with high‐resolution ultrasound in 1309 study participants with a mean age of 35 years and diabetes duration of 13.8 years; 52% were men. Cox proportional hazards models evaluated the association of standardized common carotid artery IMT and internal carotid artery IMT with subsequent cardiovascular events over the next 17 years. Models were adjusted for age, sex, mean hemoglobin A1c levels, and traditional cardiovascular risk factors. Associations of common carotid artery IMT with subsequent CAD were significant after adjustment for imaging device, sex, and age (hazard ratio [HR], 1.23 per 0.09 mm [95% CI, [1.04–1.45]; P =0.0141), but did not remain significant after further adjustment for traditional risk factors and hemoglobin A1c (HR, 1.14 per 0.09 mm [95% CI, 0.97–1.33]; P =0.1206). No significant associations with subsequent coronary artery disease events were seen for internal carotid artery IMT. Conclusions In the DCCT/EDIC cohort with type 1 diabetes, common carotid artery IMT, but not internal carotid artery IMT, is weakly associated with subsequent coronary artery events, an association eliminated after adjusting for coexistent traditional cardiovascular risk factors. Registration URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT00360815 and NCT00360893.

scholarly journals TCT-505 Impact of coronary artery disease presence on the long-term follow-up of carotid artery stenting

2013 ◽  
Vol 62 (18) ◽  
pp. B154
Author(s):  
Salech Arif ◽  
Stanislaw Bartus ◽  
Artur Dziewierz ◽  
Tomasz Rakowski ◽  
Michał Brzeziński ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Long Term Follow Up ◽  
Artery Disease

scholarly journals Carotid artery stenting in patients with symptomatic coronary artery disease

2000 ◽  
Vol 41 (1) ◽  
pp. 89 ◽  
Author(s):  
Young Sup Yoon ◽  
Won Heum Shim ◽  
Seung Min Kim ◽  
Kyung Jin Park ◽  
Seung Yun Cho
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Symptomatic Coronary Artery Disease ◽  
Artery Disease

Treatment of Carotid Artery Stenosis by Elective Stent Placement Instead of Carotid Endarterectomy in Patients with Severe Coronary Artery Disease

1999 ◽  
Vol 82 (S 01) ◽  
pp. 176-180 ◽  
Author(s):  
Jochen Krämer ◽  
Peter Vogel ◽  
Ingrid Friedrich ◽  
C. Michael Gross ◽  
Frank Uhlich ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenting ◽  
Severe Coronary Artery Disease ◽  
Stent Deformation ◽  
Severe Coronary Artery ◽  
Artery Disease

SummaryPatients with concomitant cardiac and cerebrovascular disease undergoing revascularization procedures are at high risk of both, cardiac and cerebrovascular complications. The purpose of our study was to evaluate the feasibility of prior elective carotid artery stenting as an alternative treatment procedure to carotid endarterectomy (CEA) in patients with concomitant coronary artery disease (CAD), who clearly needed coronary revascularization. We offered extracranial internal carotid stenting to 85 patients with 89 significant carotid stenoses. Out of these, 19 patients were symptomatic. The quantitative mean reduction in diameter was 77 ± 11%. Stent implantation was successful in 88 lesions. Two disabling major and 3 reversible minor strokes occurred periprocedurally. Three patients showed asymptomatic restenosis and stent deformation was detected in 2 patients. Based on this experience, carotid stenting in high risk patients with severe coronary artery disease is feasible and safe and might be indicated as an alternative procedure for combined surgery.

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