An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors

Introduction: Haemodynamic depression is a drop in systolic pressure below 90 mmHg and/or heart rate to less than 60 beats per minute. Its incidence during the carotid angioplasty and stenting (CAS) perioperative period is as high as 68%. It is suggested that haemodynamic depression may result in serious perioperative incidents (major adverse cardiac events -MACE) and strokes. Aim: To evaluate the incidence of haemodynamic depression and to attempt to find a relationship with specific risk factors in patients undergoing carotid angioplasty and stenting. Material and methods: The study involved a group of 23 patients aged 40 to 79 (13 men and 10 women) who underwent CAS between August 2009 and July 2010. Initial values of arterial pressure and heart rate, values at moments critical for successful CAS and values at the end of the procedure were recorded. Haemodynamic depression was defined as hypotension below 90 mmHg and/or bradycardia below 60 beats per minute. Results: The incidence of haemodynamic depression was 30.4%. There is a positive and statistically significant correlation between initial systolic pressure and systolic and diastolic pressure and heart rate measured during stent implantation. Gender, artery operated on, previous stroke/TIA or carotid endarterectomy, type 2 diabetes, ischaemic heart disease and smoking did not significantly affect the incidence of haemodynamic depression. A statistically significant correlation with the length of the implanted stent was observed. Conclusions: The probability of haemodynamic depression is markedly higher in patients with low initial systolic pressure and longer stenosis of the carotid artery.