Effects of a staged postoperative blood pressure management protocol on cerebral perfusion stability and neurological outcomes after carotid artery stenting: a retrospective observational study

Carotid artery stenting (CAS) carries a risk of postoperative cerebral perfusion instability. This study evaluated a multidisciplinary staged blood pressure (BP) management protocol on cerebral hemodynamics and neurological outcomes. Retrospective analysis included 67 CAS patients: control group ( n = 33) received conventional BP management; intervention group ( n = 34) received staged BP protocol. Cerebral hemodynamics were assessed using transcranial Doppler (TCD), including middle cerebral artery mean flow velocity (MCA-Vm) and pulsatility index (PI). Baseline, 24 h, 48 h, and 72 h values were recorded. Preoperative MRI/MRA were reviewed for impaired perfusion surrogates. NIHSS and Barthel Index (BI) were evaluated. Intervention group showed more stable MCA-Vm and PI. MCA-Vm peaked at 24 h (72.3 ± 14.8 cm/s) then stabilized or decreased to 64.8 ± 10.4 cm/s at 72 h. PI decreased from 0.94 ± 0.18 to 0.86 ± 0.14 in the intervention group versus 0.92 ± 0.21 to 0.78 ± 0.19 in controls. Fewer BP target failures occurred (17.6% vs. 45.5%; P = 0.019), and rescue antihypertensive therapy was less frequent (17.6% vs. 42.4%; P = 0.034). NIHSS at discharge was lower (1 [IQR 1–3] vs. 3 [2–4]; P = 0.009) and BI at 30 days higher (91.5 ± 7.6 vs. 84.3 ± 10.4; P = 0.002). A small subset exhibited postoperative MCA-Vm reduction, indicating heterogeneous hemodynamic responses. Staged postoperative BP management was associated with stable TCD-derived cerebral hemodynamics and improved neurological outcomes after CAS. Findings reflect surrogate hemodynamic changes rather than absolute cerebral blood flow, emphasizing individualized, monitored BP management.