Hemodynamic Instability Following Carotid Artery Stenting
Hemodynamic Instability Following Carotid Artery Stenting
Hemodynamic instability was controlled in 27 patient during carotid stenting and it was
 showed that hemodynamic instability can be predicted by Valsalva maneuver before stenting and
 hemodynamic instability have no prognostic effect on result of carotid stenting.
One of the important complications of Carotid Artery Stenting (CAS) is post procedural
 hypotension and bradycardia referred to as Hemodynamic Instability (HI). However its
 incidence and contribution to short-term prognosis of patients have been of a large debate.
 In this study we aim to assess the incidence and predictive factors of HI and its role in
 mortality and morbidity of patients in short-term follow-up.

 Materials and Methods: 27 patients were selected based on NASCET criteria and underwent CAS
 between September 2008 and September 2009. Continuous EKG monitoring & supine blood pressure
 (BP) was obtained before and after stent deployment and on the following day to detect HI
 defined as systolic BP≤90mmHg or heart rate≤60 beats per minute. Patients were asked to
 perform Valsalva maneuver before and after stent deployment. Valsalva ratio along with other
 demographic and procedural data was documented and compared between patients with and without
 incidence of HI.

 Results: 17 patients (63%) developed HI after CAS. The degree of stenosis was found to have a
 significant correlation with occurrence of HI with P value<0.006. No other risk factor or
 demographic data showed any correlation with HI. Valsalva Ratio (VR) were significantly lower
 in HI group compared with non-HI group indicating a significant autonomic dysfunction
 (P<0.003). In the follow-up one (4.3%) patient had developed major stroke and others were
 symptom free.

 Conclusion: HI occurs frequently following CAS but seems to be a benign phenomenon and
 doesn't increase the risk of mortality or morbidity after the procedure in short-term. VR at
 rest (VR≤1.10) baseline autonomic dysfunction and degree of carotid artery stenosis can be
 used as measures for prediction of HI after CAS.
Inclusion Criteria:

 -  every patient with carotid stenting

 Exclusion Criteria:

 -  presence of hemodynamic instability and low BP at baseline

 -  atrial fibrillation

 -  unstable patients with recent TIA and CVA in last week

 -  inability of patient to hold respiration for 30 seconds

 -  refusal of patient