Neurointervention.  2016 Sep;11(2):120-126. 10.5469/neuroint.2016.11.2.120.

Prediction of Prolonged Hemodynamic Instability During Carotid Angioplasty and Stenting

Affiliations
  • 1Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea.
  • 2Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea. jjs6553@daum.net
  • 3Department of Neurology, Konkuk University College of Medicine, Seoul, Korea.
  • 4Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Neurosurgery, Bundang Jesaeng Hospital, Bundang, Korea.
  • 6Department of Neurosurgery, Catholic University College of Medicine, Incheon, Korea.

Abstract

PURPOSE
The aim of this study was to assess the risk factors of prolonged hemodynamic instability (HDI) after carotid angioplasty and stenting (CAS). Herein, a simplified predictive scoring system for prolonged HDI is proposed.
MATERIALS AND METHODS
Sixty-six patients who had CAS from 2011 to 2016 at a single institution were evaluated. Prolonged HDI was defined as systolic blood pressure >160 mm Hg or <90 mm Hg or heart rate <50 beats/min, lasting over 30 minutes despite medical treatments. For the study, clinical data and radiologic data, including plaque morphology and stenosis were analyzed.
RESULTS
Prolonged HDI was observed in 21 patients (31.8%). Multivariable analysis revealed that calcification (OR, 6.726; p=0.006), eccentric stenosis (OR, 3.645; p=0.047) and extensive plaque distribution (OR, 7.169; p=0.006) were related to prolonged HDI. According to these results, a simplified scoring scale was proposed based on the summation of points: 2 points for calcified plaque, 2 points for extensive plaque distribution, and 1 point for eccentric stenosis. The percentages of prolonged HDI according to the total score were as follows: score 0, 8.7%; score 1, 20.0%; score 2, 38.5%; score 3, 72.7%; score 4, 66.7%; score 5, 100%. From the analysis, the total score in patients with prolonged HDI was significantly higher than those without prolonged HDI (p<0.001).
CONCLUSION
Prolonged HDI can be associated with calcification of plaque, eccentric stenosis and extensive plaque distribution, and a simplified scoring system enables prediction of prolonged HDI according to our cohort.

Keyword

Carotid angioplasty and stenting; Hemodynamic instability; Stent

MeSH Terms

Angioplasty*
Blood Pressure
Cohort Studies
Constriction, Pathologic
Heart Rate
Hemodynamics*
Humans
Risk Factors
Stents*

Figure

  • Fig. 1 Probability of prolonged hemodynamic instability in our cohort stratified by risk score.

  • Fig. 2 Graph demonstrating statistical difference in risk scores between two groups, with or without prolonged hemodynamic instability, after carotid angioplasty and stenting. The total score in patients with prolonged HDI (2.4±1.3) is significantly higher than those without prolonged HDI (0.9±1.1) (p< 0.001).


Cited by  1 articles

Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature
Young Dae Cho, Sung-Eun Kim, Jeong Wook Lim, Hyuk Jai Choi, Yong Jun Cho, Jin Pyeong Jeon
J Korean Neurosurg Soc. 2018;61(4):458-466.    doi: 10.3340/jkns.2017.0202.001.


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