Hemodynamic Depression of Early Carotid Revascularization on Ischemic Stroke Patients with Symptomatic Carotid Stenosis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic carotid stenosis in ischemic stroke patients (n=69). Intervention: Early carotid revascularization (within 2 weeks of stroke onset) vs. Late carotid revascularization (after 2 weeks of stroke onset). Primary outcome: Hemodynamic depression (hypotension or bradycardia within 5 days of procedure) (p=0.449).

Jun Woo Kim; Young-Rok Do

doi:10.18700/jnc.170012

October 12, 2017Journal of Neurocritical CareOpen Access

Hemodynamic Depression of Early Carotid Revascularization on Ischemic Stroke Patients with Symptomatic Carotid Stenosis

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Key result

Early carotid revascularization within two weeks of stroke onset did not significantly increase the incidence of hemodynamic depression compared to late revascularization (48.0% vs. 38.6%, P=0.449).

Why the study?

Does early carotid revascularization increase the incidence of hemodynamic depression compared to late carotid revascularization in ischemic stroke patients with symptomatic carotid stenosis?

Study Design

Type

Cohort (n=69)

Multicenter

No

Structured PICO

Does early carotid revascularization increase the incidence of hemodynamic depression compared to late carotid revascularization in ischemic stroke patients with symptomatic carotid stenosis?

P

Population

69 ischemic stroke patients (mean age 70.7, 26.1% female) with symptomatic carotid stenosis (≥50%) who underwent carotid revascularization, evaluated retrospectively for hemodynamic depression.

E

Exposure

Early carotid revascularization (carotid artery stenting or endarterectomy performed within two weeks of stroke onset)

C

Comparator

Late carotid revascularization (carotid artery stenting or endarterectomy performed after two weeks following stroke onset)

O

Outcome

Hemodynamic depression (HD), defined as a systolic blood pressure of less than 90 mmHg or pulse rate of less than 50 times/minute occurring at least once within five days during and following carotid revascularizationsafety

Main Result

Absolute Event Rate: 48% vs 38.6%

p-value: p=0.449

Early carotid revascularization within two weeks of an ischemic stroke is as safe as late revascularization regarding the risk of periprocedural hemodynamic depression.

Limitations

Single-center retrospective design
Small sample size
Failed to evaluate site and length of stenosis, calcification, plaque morphology, contralateral stenosis, and ballooning pressure
No access to preoperative cardiology evaluation, HD duration, and clinical events
Intravenous medication for HD requiring treatment was not administered using identical criteria
Single-center, retrospective nature
Small number of patients enrolled
Failed to evaluate the site and length of the stenosis, presence of calcification, morphology of the plaque, presence of stenosis on the contralateral side, and ballooning pressure on the CAS
No access to data regarding preoperative cardiology evaluation, HD duration, and clinical events

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports early revascularization feasibility in this cohort; leaves open randomized confirmation of hemodynamic safety.

Abstract

Background: Carotid revascularization is frequently complicated by hemodynamic depression (HD), which can increase the risk of stroke or vascular death.However, no studies yet exist describing the correlation between the timing of carotid revascularization and HD.The present study investigated whether carotid revascularization in the early phase of a stroke had an impact on the incidence of HD.Methods: A retrospective study of consecutive ischemic stroke patients who underwent carotid revascularization was designed to compare the incidence of HD between early and late carotid revascularization.Early carotid revascularization was defined as carotid artery stenting or endarterectomy within two weeks of stroke onset.HD was defined as hypotension or bradycardia within five days of carotid revascularization.Results: Of 69 carotid revascularizations, HD occurred in 29 (42.0%).The incidence of HD did not differ significantly between the early and late phase groups (48.0% vs. 38.6%,respectively, P=0.449).Patients with HD had undergone more carotid artery stenting than those without HD (79.3% vs. 35%, respectively, P<0.001).Age, sex, hypertension, diabetes, heart disease, antihypertensive medication, and severity of carotid stenosis did not differ between patients with and without HD. Conclusion:The present research suggests that early carotid revascularization is as safe as late carotid revascularization with regard to HD.

Discussion

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Cite This Study

Kim et al. (2017) conducted a cohort in Symptomatic carotid stenosis in ischemic stroke patients (n=69). Early carotid revascularization (within 2 weeks of stroke onset) vs. Late carotid revascularization (after 2 weeks of stroke onset) was evaluated on Hemodynamic depression (hypotension or bradycardia within 5 days of procedure) (p=0.449). Early carotid revascularization within two weeks of stroke onset did not significantly increase the incidence of hemodynamic depression compared to late revascularization (48.0% vs. 38.6%, P=0.449).

synapsesocial.com/papers/6a9ef46922911fa3b2454c1a https://doi.org/10.18700/jnc.170012

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Hemodynamic Depression of Early Carotid Revascularization on Ischemic Stroke Patients with Symptomatic Carotid Stenosis

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Hemodynamic Depression of Early Carotid Revascularization on Ischemic Stroke Patients with Symptomatic Carotid Stenosis

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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