Acute hemodynamic changes during carotid artery stenting

Farrell O. Mendelsohn, Neil J. Weissman, Robert J. Lederman, James J. Crowley, John L. Gray, Harry R. Phillips, Mark J. Alberts, Richard L. McCann, Tony P. Smith, Richard S. Stack

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

To determine the clinical significance of acute hemodynamic disturbances during stenting in the carotid sinus region, we assessed the relation between intraprocedural changes in heart rate (HR) and blood pressure (BP) and adverse neurologic and cardiac outcomes. Eighteen patients underwent carotid stenting with the Wallstent (Schneider Inc). Suitable candidates had at least 60% diameter stenosis of the carotid artery by angiography. Initial and nadir HR and BP were recorded during the predilatation, stent delivery, and postdilatation periods. Bradycardia was defined as HR ≤60 beats/min and hypotension as systolic BP ≤100 mm Hg. Nineteen Wallstents were successfully deployed in all 19 carotid arteries. Some degree of bradycardia or hypotension occurred in 68% of carotid stent procedures, but administration of vasoactive medications was necessary in only 7 patients (37%) with more persistent hemodynamic disturbances. Hypotension or the need for continuous vasopressor therapy was significantly more common during postdilatation (32%) than in the predilatation period (5%) (p = 0.02). Bradycardia was not reduced by prophylactic atropine. In 1 patient the hemodynamic response to stenting may have contributed to an adverse neurologic and cardiac outcome. Thus, despite frequent fluctuations in HR and BP, most carotid stenting procedures were performed with excellent overall results, even in patients at high risk.

Original languageEnglish
Pages (from-to)1077-1081
Number of pages5
JournalAmerican Journal of Cardiology
Volume82
Issue number9
DOIs
StatePublished - Nov 17 1998
Externally publishedYes

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Carotid Arteries
Hemodynamics
Blood Pressure
Bradycardia
Heart Rate
Hypotension
Nervous System
Stents
Carotid Sinus
Carotid Stenosis
Atropine
Angiography
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mendelsohn, F. O., Weissman, N. J., Lederman, R. J., Crowley, J. J., Gray, J. L., Phillips, H. R., ... Stack, R. S. (1998). Acute hemodynamic changes during carotid artery stenting. American Journal of Cardiology, 82(9), 1077-1081. https://doi.org/10.1016/S0002-9149(98)00562-1

Acute hemodynamic changes during carotid artery stenting. / Mendelsohn, Farrell O.; Weissman, Neil J.; Lederman, Robert J.; Crowley, James J.; Gray, John L.; Phillips, Harry R.; Alberts, Mark J.; McCann, Richard L.; Smith, Tony P.; Stack, Richard S.

In: American Journal of Cardiology, Vol. 82, No. 9, 17.11.1998, p. 1077-1081.

Research output: Contribution to journalArticle

Mendelsohn, FO, Weissman, NJ, Lederman, RJ, Crowley, JJ, Gray, JL, Phillips, HR, Alberts, MJ, McCann, RL, Smith, TP & Stack, RS 1998, 'Acute hemodynamic changes during carotid artery stenting', American Journal of Cardiology, vol. 82, no. 9, pp. 1077-1081. https://doi.org/10.1016/S0002-9149(98)00562-1
Mendelsohn FO, Weissman NJ, Lederman RJ, Crowley JJ, Gray JL, Phillips HR et al. Acute hemodynamic changes during carotid artery stenting. American Journal of Cardiology. 1998 Nov 17;82(9):1077-1081. https://doi.org/10.1016/S0002-9149(98)00562-1
Mendelsohn, Farrell O. ; Weissman, Neil J. ; Lederman, Robert J. ; Crowley, James J. ; Gray, John L. ; Phillips, Harry R. ; Alberts, Mark J. ; McCann, Richard L. ; Smith, Tony P. ; Stack, Richard S. / Acute hemodynamic changes during carotid artery stenting. In: American Journal of Cardiology. 1998 ; Vol. 82, No. 9. pp. 1077-1081.
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