Abstract Number: Esoc2026a67 Hemodynamic Depression and Autonomic Activity Changes in Carotid Artery Stenting

Abstract Background and aims Carotid artery stenting (CAS) is frequently complicated by hemodynamic depression (HD). This study aimed to evaluate the effect of CAS on autonomic function and its association with HD. Methods This prospective cohort study enrolled patients with atherosclerotic stenosis at the carotid sinus who underwent CAS. Perioperative autonomic function was assessed using long-term electrocardiographic monitoring and heart rate variability analysis. Specific indices—sympathetic activity index (SAI) and parasympathetic activity index (PAI)—were derived from orthonormal Laguerre basis expansions based on heartbeat time series. Post-stenting hypotension and bradycardia were defined as systolic blood pressure 90 mmHg or heart rate 60 beats/min, respectively, lasting more than 6 hours. Longitudinal associations between autonomic function and HD were evaluated using generalized linear mixed models. Results A total of 735 patients who underwent CAS between March 2020 and December 2024 were included in the final analysis, among whom 301 had valid ECG recordings. Compared with the pre-stenting phase, SAI decreased and PAI increased after CAS (both P 0.001). Patients who developed hypotension or bradycardia exhibited greater changes in autonomic indices (both P 0.001). Mediation analysis indicated that SAI and PAI significantly mediated the effect of CAS on both hypotension and bradycardia (all P 0.001). Conclusions CAS induces significant alterations in autonomic activity, which are associated with the development of HD. Long-term ECG monitoring combined with HRV analysis may help identify the underlying etiology of hypotension, such as hypovolemia or autonomic reflex mechanisms, facilitating targeted management. Conflict of interest Le Cao, Hang Wang, and Bo Wu: nothing to disclose