BACKGROUND: Carotid endarterectomy and carotid artery stenting are frequently complicated by hemodynamic instability. AIMS: The study aims to compare the incidence of hemodynamic complications between carotid artery stenting and carotid endarterectomy in the International Carotid Stenting Study (ISRCTN25337470). METHODS: Patients with symptomatic carotid stenosis were randomly allocated to carotid artery stenting or carotid endarterectomy. The occurrence of peri-procedural hemodynamic depression (severe bradycardia, asystole, or hypotension requiring treatment) and hypertension requiring treatment was assessed in a per-protocol analysis. We compared the rate of hemodynamic complications, determined independent predictors thereof, and assessed their relation with the composite outcome of all-cause death, stroke, and myocardial infarction within 30 days of treatment. RESULTS: A number of 766 carotid artery stenting and 819 carotid endarterectomy patients had a single completed intervention. Hemodynamic depression occurred in 13.8% after carotid artery stenting and in 7.2% after carotid endarterectomy (relative risk 1.9, 95% confidence interval 1.4-2.6, P < 0.0001). Hypertension requiring treatment occurred less often after carotid artery stenting than after carotid endarterectomy (relative risk 0.2, 95% confidence interval, 0.1-0.4, P < 0.0001). In carotid artery stenting patients, a history of cardiac failure was the trongest independent predictor of hemodynamic depression (relative risk 2.4, 95% confidence interval 1.3-4.8, P = 0.009). There was no statistically significant association between hemodynamic complications and the occurrence of the composite outcome. CONCLUSION: Hemodynamic depression occurs more often after carotid artery stenting and severe hypertension more often after carotid endarterectomy, but these complications are not responsible for the excess of major perioperative events after carotid artery stenting.
BACKGROUND: Carotid endarterectomy and carotid artery stenting are frequently complicated by hemodynamic instability. AIMS: The study aims to compare the incidence of hemodynamic complications between carotid artery stenting and carotid endarterectomy in the International Carotid Stenting Study (ISRCTN25337470). METHODS: Patients with symptomatic carotid stenosis were randomly allocated to carotid artery stenting or carotid endarterectomy. The occurrence of peri-procedural hemodynamic depression (severe bradycardia, asystole, or hypotension requiring treatment) and hypertension requiring treatment was assessed in a per-protocol analysis. We compared the rate of hemodynamic complications, determined independent predictors thereof, and assessed their relation with the composite outcome of all-cause death, stroke, and myocardial infarction within 30 days of treatment. RESULTS: A number of 766 carotid artery stenting and 819 carotid endarterectomy patients had a single completed intervention. Hemodynamic depression occurred in 13.8% after carotid artery stenting and in 7.2% after carotid endarterectomy (relative risk 1.9, 95% confidence interval 1.4-2.6, P < 0.0001). Hypertension requiring treatment occurred less often after carotid artery stenting than after carotid endarterectomy (relative risk 0.2, 95% confidence interval, 0.1-0.4, P < 0.0001). In carotid artery stenting patients, a history of cardiac failure was the trongest independent predictor of hemodynamic depression (relative risk 2.4, 95% confidence interval 1.3-4.8, P = 0.009). There was no statistically significant association between hemodynamic complications and the occurrence of the composite outcome. CONCLUSION: Hemodynamic depression occurs more often after carotid artery stenting and severe hypertension more often after carotid endarterectomy, but these complications are not responsible for the excess of major perioperative events after carotid artery stenting.
Authors: D Doig; E L Turner; J Dobson; R L Featherstone; G J de Borst; G Stansby; J D Beard; S T Engelter; T Richards; M M Brown Journal: Eur J Vasc Endovasc Surg Date: 2015-10-14 Impact factor: 7.069
Authors: Serkan Burç Deşer; Semih Murat Yucel; Mustafa Kemal Demirag; Fersat Kolbakir; Hasan Tahsin Keceligil Journal: Braz J Cardiovasc Surg Date: 2019 Mar-Apr
Authors: K Kapnisis; H Seidner; M Prokopi; D Pasias; C Pitsillides; A Anayiotos; E Kaliviotis Journal: Clin Hemorheol Microcirc Date: 2019 Impact factor: 2.375
Authors: Lauro A C Bogniotti; Marcelo P Teivelis; Francisco A M Cardozo; Bruno Caramelli; Nelson Wolosker; Pedro Puech-Leão; Nelson De Luccia; Daniela Calderaro Journal: Clinics (Sao Paulo) Date: 2022-09-08 Impact factor: 2.898