Yonsei Med J.  2013 Mar;54(2):295-300. 10.3349/ymj.2013.54.2.295.

Hemodynamic Instability during Carotid Angioplasty and Stenting-Relationship of Calcified Plaque and Its Characteristics

• Jeon JS
• Sheen SH
• Hwang G

• KMID: 1503888
• DOI: http://doi.org/10.3349/ymj.2013.54.2.295

Abstract

PURPOSE
During carotid angioplasty and stenting (CAS), hemodynamic instability (HDI) can occur, possibly causing post-procedural ischemic complications. The goal of this study was to investigate the risk factors of HDI focusing on characteristics of plaque.
MATERIALS AND METHODS
Thirty nine CAS patients were retrospectively evaluated for HDI. Prolonged HDI that lasted over 30 minutes was analyzed in relation to characteristics of calcified plaque.
RESULTS
Nineteen (48.7%) patients had HDI. Ten of the 19 had both bradycardia and hypotension, and nine had only bradycardia. All bradycardia was treated well with a transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension in spite of recovery of bradycardia. Calcified plaque was a related factor associated with HDI (odds ratio, 8.571; 95% confidence interval, 1.321-55.62; p=0.024). Extensive and eccentric type calcified plaques were associated with prolonged hypotension (p=0.04, and p=0.028, respectively).
CONCLUSION
The calcification of plaque is a predictable factor of HDI during CAS, and its extensive and eccentric calcified plaques may be related to prolonged HDI.

Keyword

Carotid angioplasty and stenting; hemodynamic instability; bradycardia; hypotension

MeSH Terms

Aged
Angioplasty/*adverse effects
Bradycardia/complications
Carotid Arteries/*surgery
Carotid Stenosis/*physiopathology
Female
*Hemodynamics
Humans
Hypotension/complications
Intraoperative Complications/*etiology/radiography
Intraoperative Period
Logistic Models
Male
Middle Aged
Retrospective Studies
Risk Factors
Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 The classification of plaque on distribution of longitudinal image. (a) Extensive plaque located from CCA to ICA within 5 mm from bifurcation (arrow) on both sides. (b) Proximal plaque included ICA within 5 mm from bifurcation. (c) Distal plaque included ICA beyond 5 mm from bifurcation. CCA, common carotid artery; ICA, internal carotid artery.

• 

  Fig. 2 Carotid CT and Dyna-CT show the classification of calcified plaque on distribution of cross-sectional image. (A) Eccentric calcified plaque. (B) Concentric calcified plaque.

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