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October 14, 2026Open Access

Blood pressure improvement and long-term outcomes after carotid stenting in patients with hypertension and atherosclerotic carotid stenosis

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Key result

Post-CAS blood pressure improvement is linked to ~11-point lower 24-month MACCE incidence.

P=0.048
n=178

Why the study?

The relationship between long-term blood pressure improvement following carotid stenting and clinical outcomes in patients with hypertension and atherosclerotic carotid stenosis needed to be investigated.

Does long-term blood pressure improvement following carotid artery stenting improve 24-month major adverse cardiovascular and cerebrovascular event (MACCE)-free survival in patients with hypertension and severe symptomatic atherosclerotic carotid stenosis?

Key Points

To evaluate whether sustained blood pressure improvement following carotid artery stenting is associated with long-term clinical outcomes in patients with hypertension and carotid stenosis.
Retrospective analysis of 178 patients who underwent carotid artery stenting, grouped by 24-month blood pressure improvement (BP-I, n=59), nonimprovement (BP-NI, n=77), and nonhypertensive controls (n=42).
Major adverse cardiovascular and cerebrovascular event (MACCE)-free survival was assessed at 24 months using Kaplan–Meier analysis and multivariable Cox proportional hazards modeling.
Blood pressure improvement was achieved in 43.4% of patients, and MACCE-free survival was significantly higher in the BP-I group than in the BP-NI group at 24 months (log-rank p=0.048; MACCE rate 6.8% vs. 18.2%).
Patients in the BP-I group experienced greater perioperative hemodynamic instability, requiring higher dopamine doses (1.39 ± 3.04 mg vs. 0.75 ± 1.77 mg, p<0.01) and experiencing prolonged hypotension >24 hours more frequently (28.8% vs. 19.5%, p=0.01).
Multivariate Cox regression showed preoperative systolic blood pressure ≥140 mmHg was an independent risk factor for MACCEs (HR=6.26; 95% CI: 2.26–17.35; p<0.001), while moderate-to-high plaque echogenicity (HR=0.29; 95% CI: 0.10–0.82; p=0.019) and stent diameter >8 mm (HR=0.13; 95% CI: 0.03–0.48; p=0.002) were protective.

Study Design

Type

Cohort (n=178)

Multicenter

Yes

Structured PICO

Does long-term blood pressure improvement following carotid artery stenting improve 24-month major adverse cardiovascular and cerebrovascular event (MACCE)-free survival in patients with hypertension and severe symptomatic atherosclerotic carotid stenosis?

P

Population

178 patients <80 years old with symptomatic severe carotid artery stenosis (≥70% ECST) undergoing carotid artery stenting (136 hypertensive and 42 nonhypertensive controls), followed for 24 months.

E

Exposure

Carotid artery stenting (CAS) using a self-expanding stent with cerebral protection device, plus periprocedural dual-antiplatelet therapy (aspirin 100 mg once daily and clopidogrel 75 mg once daily) and atorvastatin 20 mg daily for at least 3 days before and 3 months after the procedure, followed by daily aspirin 100 mg and atorvastatin 20 mg; analyzed specifically in patients achieving long-term blood pressure improvement at 24 months (BP-I group, n=59).

C

Comparator

Patients undergoing the same carotid artery stenting and medical regimen who did not achieve blood pressure improvement at 24 months (BP-NI group, n=77) and nonhypertensive patients undergoing CAS (blank control group, n=42).

O

Outcome

Major adverse cardiovascular and cerebrovascular event (MACCE)-free survival rate at 24 months, defined as a composite of all-cause death, any stroke, and myocardial infarction, evaluated by a certified independent neurologist.composite

Main Result

Absolute Event Rate: 6.8% vs 18.2%

p-value: p=0.048

Long-term blood pressure improvement occurs in 43.4% of hypertensive patients after carotid artery stenting and is associated with significantly higher 24-month MACCE-free survival compared to those without blood pressure improvement.

Limitations

Retrospective study design with potential selection bias and unmeasured confounding factors
Relatively small sample size limiting statistical power, particularly for low-incidence events
Reliance on static office blood pressure recordings rather than 24-hour ambulatory blood pressure monitoring (ABPM)
Retrospective study design, meaning selection bias and confounding factors cannot be completely ruled out
Relatively small sample size, which may have affected statistical power particularly when assessing low-incidence events
Blood pressure measurements relied primarily on static clinical recordings rather than 24-hour ambulatory blood pressure monitoring (ABPM)

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Implication

BP improvement after carotid stenting may link to lower MACCE; hypothesis-generating and requires prospective confirmation before clinical adoption.

Abstract

Background: This study aimedto investigate the relationship between long-term blood pressure improvement following carotid stenting (CAS) and clinical outcomes. Methods: In thisstudy,178 patients with hypertensive and carotid stenosis who underwent CAS were retrospectively analyzedand divided into a blood pressure improvementgroup (BP-I, n=59) and a blood pressure nonimprovement group (BP-NI, n=77) on the basis of whether their blood pressure improved at 24 months;the other 42 nonhypertensive patients were considered blank controls (BCs). The primary outcome was the major adverse cardiovascular and cerebrovascular event(MACCE)-free survival rate at 24months. Survival analysis was performed using the Kaplan‒Meiermethod, and Cox proportional hazards models were employed to identify potential predictors of MACCEs. Results: Blood pressure improvement wasachieved by 43.4% of the patients. The MACCE-free survival rate was significantly greater in the BP-I group than in the BP-NI group (P=0.048) at 24 months, and no difference was detected between the BP-I and BC groups; the MACCE-free survival rate was higher in the BC group, but the difference was not significant. Perioperative hemodynamics were less stable in the BP-I group, as these patients required significantly more dopamine support (p<0.01) and experiencedlonger durations of hypotension (p=0.01) than the patients in the BP-NI group did. Multivariate Cox regression revealed that a preoperative systolic blood pressure ≥140 mmHg was the strongest independent risk factor for MACCEs (HR=6.26; p<0.001), while moderate-to-high echogenicity plaques (HR=0.29; p=0.019) and a stent diameter >8 mm (HR=0.13; p=0.002) were significant protective factors. Conclusion: Long-term blood pressure improvement following CAS is a potential indicator of better long-term outcomes. Clinical trial number： not applicable

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Cite This Study

Zhang et al. (2026) conducted a cohort in Hypertension and atherosclerotic carotid stenosis treated with carotid artery stenting (n=178). Long-term blood pressure improvement after carotid artery stenting (BP-I) vs. Blood pressure nonimprovement after carotid artery stenting (BP-NI) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, any stroke, and myocardial infarction) at 24 months (p=0.048). Long-term blood pressure improvement after carotid stenting was associated with lower 24-month MACCE incidence compared with non-improvement (6.8% vs 18.2%; log-rank P=0.048).

synapsesocial.com/papers/6ae682a3e432e7a5c4ef35e8 https://doi.org/10.21203/rs.3.rs-10895368/v1

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