Correlation of Periprocedural Systolic Blood Pressure Changes with Neurological Events in High-Risk Carotid Stent Patients

PURPOSE: To examine retrospectively the magnitude of change in systolic blood pressure (SBP) during carotid artery stenting and its relationship to neurological events. METHODS: In a 5-year period ending October 2000, 60 patients (36 men; mean age 67 +/- 9 years) were enrolled in a study to evaluate stenting in symptomatic or asymptomatic high-risk patients with > or =70% carotid artery stenosis. The majority (48, 80%) of the patients were symptomatic. Five patients with bilateral lesions were treated in staged procedures. Sixteen (25%) of the 65 lesions were postsurgical stenoses and 12 (18%) were secondary to neck radiation therapy. RESULTS: There were 2 (3%) minor and 2 (3%) major strokes (94% procedural success), of which 1 was fatal. Six (9%) transient neurological events were recorded during balloon inflation. The mean SBP change during or after stenting in 55 cases without neurological events was 34 +/- 14 mmHg, while the patients with transient or permanent neurological events had significantly greater changes in SBP (107 +/- 31 mmHg [p<0.003] and 134 +/- 14 mmHg [p<0.001], respectively). Patients exhibiting neurological sequelae had significantly higher SBP before the procedure than those without complications (203 +/- 30 versus 165 +/- 23 mmHg, p<0.001). There were no neurological events in patients with a <50-mmHg change in SBP. CONCLUSIONS: Patients with severely elevated baseline SBP (>180 mmHg) may be at higher risk for hemodynamic instability and neurological events during carotid stenting. The greater the change in SBP, the more severe the neurological event seems to be, but further studies in a greater number of patients are needed to evaluate the potential causes of SBP fluctuations in an effort to avoid neurological events.