HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

Abstract Background Ischemic stroke ranks at the forefront of the global spectrum of causes of death. Internal carotid artery stenosis is one of the causes of ischemic stroke, and CAS is an important method to treat internal carotid artery stenosis. However, postoperative hypotension and other complications can lead to serious neurological defects. Methods The clinical data and imaging data of patients with internal carotid artery stenosis treated by stenting in the Department of Neurology of the Second Affiliated Hospital of Xinjiang Medical University from January 2021 to December 2023 were collected for statistical analysis. Results A total of 23 patients were enrolled, 87% were male, the median age of onset was 65 years (IQR, 57-71 years), 56.2% had a history of smoking, 82.6% had hypertension, 78.9% had poor blood pressure control, 47.8% had a chronic disease, 81.8% of whom were hypertensive. Before admission, 74% of the patients had transient or persistent neurological impairment, that is TIA or IS at any stage. Of the 46 internal carotid arteries in 23 patients, 25 (54.3%) had severe stenosis, 60.9% had bilateral stenosis, and 85.7% mainly had bi-focal or severe and moderate stenosis on one side. 60.9% developed postoperative hypotension, of which 57.1% were treated with vasoactive drugs. Only HDL levels were different in the three groups with normal blood pressure, rehydration after hypotension, and medication after hypotension. Conclusions HDL level does not predict whether blood pressure will decrease after surgery, but if carotid sinus response occurs, high HDL (≧1.0mmol/L) may be more likely to require vasopressor therapy while low HDL (<1.0mmol/L) can be treated with fluid rehydration.