Key result
Bradycardia or hypotension during carotid stenting links to decreased rSO2 and increased postprocedural CBF.
Why the study?
Hemodynamic instability during and after carotid artery stenting may reduce cerebral blood flow, leading to cerebral ischemia, but changes in cerebral blood flow during the periprocedural period are not well characterized.
Does intraprocedural hemodynamic instability affect regional cerebral oxygen saturation and cerebral blood flow in patients undergoing carotid artery stenting?
Observational (n=46)
Does intraprocedural hemodynamic instability affect regional cerebral oxygen saturation and cerebral blood flow in patients undergoing carotid artery stenting?
p-value: p=<0.01
Hemodynamic instability during carotid artery stenting is associated with decreased intraprocedural cerebral oxygen saturation and subsequent postprocedural hyperperfusion.
May warrant closer hemodynamic monitoring during carotid stenting; leaves open effects on clinical outcomes.
SUMMARY: Hemodynamic instability during and after carotid artery stenting (CAS) may reduce cerebral blood flow (CBF), leading to cerebral ischemia. To investigate changes in CBF in the periprocedural period, we continuously recorded the regional cerebral oxygen saturation (rSO2) using near-infrared spectroscopy. In 46 consecutive patients with carotid artery stenosis, rSO2 was continuously recorded during and after CAS. In addition, the patients underwent SPECT to evaluate a change in CBF on the next day after CAS. Introprocedural bradycardia (heart rate < 50 bpm) occurred in 21 patients (46%) including one transient cardiac arrest. Intraprocedural hypotension (systolic blood pressure < 80 mmHg) occurred in 18 patients (39%), and 16 of them showed prolonged hypotension. The rSO2 in patients with bradycardia/hypotension during CAS was significantly less than that in patients without them (p < 0.01). Moreover, the SPECT on the next day after CAS demonstrated that the ipsilateral CBF in patients with bradycardia/hypotension during CAS significantly more than that in patients without them (p < 0.05). Intraprocedural hemodynamic instability resulted in a significant decrease in rSO2, leading to a possible severe cerebral ischemia. In addition, intraprocedural bradycardia/hypotension might be related with postprodedural hyperperfusion, causing the morbidity and mortality after CAS.
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Kamii et al. (2007) conducted an observational in Carotid artery stenosis (n=46). Intraprocedural bradycardia or hypotension vs. No intraprocedural bradycardia or hypotension was evaluated on Regional cerebral oxygen saturation (rSO2) (p=<0.01). Intraprocedural bradycardia or hypotension during carotid stenting significantly decreased regional cerebral oxygen saturation (p<0.01) and increased postprocedural cerebral blood flow (p<0.05).
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