Can periprocedural hypotension in carotid artery stenting be predicted? A carotid morphologic autonomic pathologic scoring model using virtual histology to anticipate hypotension.

SUMMARY: Periprocedural hypotension, which frequently occurs during carotid artery stenting (CAS), is an important risk factor for complications such as stroke or death after CAS. To determine if a scoring model can be established to predict periprocedural hypotension (systolic blood pressure < or = 90 mm Hg) and prolonged periprocedural hypotension (requiring vasopressor for > 3 hours) in CAS, we conducted a prospective cohort study of patients undergoing interventional treatment of cervical carotid artery stenosis in an urban tertiary referral hospital from April 2006 to April 2007. Forty-eight stenotic lesions in 45 consecutive patients treated with CAS were included in the study. Multivariate analysis showed three independent risk factors of periprocedural hypotension; "fibrous plaque on Virtual Histology" (P = 0.029), "stenotic lesion involving both the common carotid artery and internal carotid artery on angiogram" (P = 0.004), and "patients without history of diabetes mellitus" (P = 0.020). Further, "distance between carotid bifurcation and point of minimum lumen size < or = 10 mm on angiogram" (P = 0.003) was an independent risk factor of prolonged periprocedural hypotension. Carotid morphologic autonomic pathologic score (carotid MAPS), determined by adding one point for each of those risk factors (total 0 to 4), had good discrimination for both periprocedural hypotension (area under receiver operating characteristic curve: ROC AUC = 0.876; SE 0.053) and prolonged periprocedural hypotension (ROC AUC = 0.811; SE 0.066). Carotid MAPS is useful for predicting periprocedural hypotension and prolonged periprocedural hypotension during CAS.