Multivariable Analysis of Patients With Severe Persistent Postprocedural Hypotension After Carotid Artery Stenting

Olufemi Oshin, Ramon Varcoe, Jackie Wong, Sally Burrows, Nishath Altaf, Markus Schlaich, Rukshen Weerasooriya, William Gray, Koen Deloose, Iris Baumgartner, Bibombe P. Mwipatayi

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Abstract

Purpose: To assess the incidence and predictors of severe, persistent postprocedural hypotension (PPH) after carotid artery stenting (CAS). Materials and Methods: A total of 146 patients (mean age 72.8 years; 104 men) who underwent 160 CAS procedures using a standardized protocol at 3 vascular centers were retrospectively analyzed. The primary endpoint was postprocedural hypotension, defined as a reduction in systolic blood pressure (SBP) >40 mm Hg from baseline or an SBP of <90 mm Hg sustained for >1 hour after CAS. Potential prognostic factors for postprocedural hypotension were identified and subjected to logistic regression analyses; outcomes are presented as the odds ratios (ORs) with 95% confidence intervals (CIs). Results: PPH developed in 36 (24.7%) patients after 37 (23.1%) CAS procedures. These patients had significantly longer intensive care unit and hospital stays than those who did not develop hypotension (p<0.001). PPH was associated with severe lesion calcification (OR 6.28, 95% CI 1.81 to 21.98, p=0.004) and contrast volume (OR 1.02, 95% CI 1.01 to 1.02, p<0.001). A 4-fold increase in the risk of PPH (OR 4.22, 95% CI 1.38 to 13.33, p=0.012) was found between the embolic protection device most associated with PPH (Angioguard) and the device least associated with PPH (Emboshield NAV6). A similar trend was also observed for the Precise vs Xact stents (OR 6, 95% CI 2.08 to 17.6, p=0.001). Bootstrapped multivariable modeling identified the Precise stent and contrast volume as significant predictors of persistent postprocedural hypotension. Further investigation of the contrast volume revealed associations with sex, severe calcification, arch type, previous coronary artery bypass surgery, and primary stenting, suggesting that the contrast volume reflects the complexity of the procedure. Conclusion: The complexity of the procedure and type of stent may play a role in the development of postprocedural hypotension after CAS.

Original languageEnglish
JournalJournal of Endovascular Therapy
DOIs
Publication statusE-pub ahead of print - 21 Aug 2019

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Carotid Arteries
Hypotension
Odds Ratio
Confidence Intervals
Blood Pressure
Stents
Embolic Protection Devices
Coronary Artery Bypass
Blood Vessels
Intensive Care Units
Length of Stay
Logistic Models
Regression Analysis
Equipment and Supplies
Incidence

Cite this

@article{5f5da26e122f4e8c81dc0f641b77b8ff,
title = "Multivariable Analysis of Patients With Severe Persistent Postprocedural Hypotension After Carotid Artery Stenting",
abstract = "Purpose: To assess the incidence and predictors of severe, persistent postprocedural hypotension (PPH) after carotid artery stenting (CAS). Materials and Methods: A total of 146 patients (mean age 72.8 years; 104 men) who underwent 160 CAS procedures using a standardized protocol at 3 vascular centers were retrospectively analyzed. The primary endpoint was postprocedural hypotension, defined as a reduction in systolic blood pressure (SBP) >40 mm Hg from baseline or an SBP of <90 mm Hg sustained for >1 hour after CAS. Potential prognostic factors for postprocedural hypotension were identified and subjected to logistic regression analyses; outcomes are presented as the odds ratios (ORs) with 95{\%} confidence intervals (CIs). Results: PPH developed in 36 (24.7{\%}) patients after 37 (23.1{\%}) CAS procedures. These patients had significantly longer intensive care unit and hospital stays than those who did not develop hypotension (p<0.001). PPH was associated with severe lesion calcification (OR 6.28, 95{\%} CI 1.81 to 21.98, p=0.004) and contrast volume (OR 1.02, 95{\%} CI 1.01 to 1.02, p<0.001). A 4-fold increase in the risk of PPH (OR 4.22, 95{\%} CI 1.38 to 13.33, p=0.012) was found between the embolic protection device most associated with PPH (Angioguard) and the device least associated with PPH (Emboshield NAV6). A similar trend was also observed for the Precise vs Xact stents (OR 6, 95{\%} CI 2.08 to 17.6, p=0.001). Bootstrapped multivariable modeling identified the Precise stent and contrast volume as significant predictors of persistent postprocedural hypotension. Further investigation of the contrast volume revealed associations with sex, severe calcification, arch type, previous coronary artery bypass surgery, and primary stenting, suggesting that the contrast volume reflects the complexity of the procedure. Conclusion: The complexity of the procedure and type of stent may play a role in the development of postprocedural hypotension after CAS.",
keywords = "calcification, carotid artery stenting, contrast medium, postprocedural hypotension, risk factors, stenosis, stent model",
author = "Olufemi Oshin and Ramon Varcoe and Jackie Wong and Sally Burrows and Nishath Altaf and Markus Schlaich and Rukshen Weerasooriya and William Gray and Koen Deloose and Iris Baumgartner and Mwipatayi, {Bibombe P.}",
year = "2019",
month = "8",
day = "21",
doi = "10.1177/1526602819869929",
language = "English",
journal = "Journal of Endovascular Therapy",
issn = "1074-6218",
publisher = "International Society of Endovascular Specialists",

}

Multivariable Analysis of Patients With Severe Persistent Postprocedural Hypotension After Carotid Artery Stenting. / Oshin, Olufemi; Varcoe, Ramon; Wong, Jackie; Burrows, Sally; Altaf, Nishath; Schlaich, Markus; Weerasooriya, Rukshen; Gray, William; Deloose, Koen; Baumgartner, Iris; Mwipatayi, Bibombe P.

In: Journal of Endovascular Therapy, 21.08.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multivariable Analysis of Patients With Severe Persistent Postprocedural Hypotension After Carotid Artery Stenting

AU - Oshin, Olufemi

AU - Varcoe, Ramon

AU - Wong, Jackie

AU - Burrows, Sally

AU - Altaf, Nishath

AU - Schlaich, Markus

AU - Weerasooriya, Rukshen

AU - Gray, William

AU - Deloose, Koen

AU - Baumgartner, Iris

AU - Mwipatayi, Bibombe P.

PY - 2019/8/21

Y1 - 2019/8/21

N2 - Purpose: To assess the incidence and predictors of severe, persistent postprocedural hypotension (PPH) after carotid artery stenting (CAS). Materials and Methods: A total of 146 patients (mean age 72.8 years; 104 men) who underwent 160 CAS procedures using a standardized protocol at 3 vascular centers were retrospectively analyzed. The primary endpoint was postprocedural hypotension, defined as a reduction in systolic blood pressure (SBP) >40 mm Hg from baseline or an SBP of <90 mm Hg sustained for >1 hour after CAS. Potential prognostic factors for postprocedural hypotension were identified and subjected to logistic regression analyses; outcomes are presented as the odds ratios (ORs) with 95% confidence intervals (CIs). Results: PPH developed in 36 (24.7%) patients after 37 (23.1%) CAS procedures. These patients had significantly longer intensive care unit and hospital stays than those who did not develop hypotension (p<0.001). PPH was associated with severe lesion calcification (OR 6.28, 95% CI 1.81 to 21.98, p=0.004) and contrast volume (OR 1.02, 95% CI 1.01 to 1.02, p<0.001). A 4-fold increase in the risk of PPH (OR 4.22, 95% CI 1.38 to 13.33, p=0.012) was found between the embolic protection device most associated with PPH (Angioguard) and the device least associated with PPH (Emboshield NAV6). A similar trend was also observed for the Precise vs Xact stents (OR 6, 95% CI 2.08 to 17.6, p=0.001). Bootstrapped multivariable modeling identified the Precise stent and contrast volume as significant predictors of persistent postprocedural hypotension. Further investigation of the contrast volume revealed associations with sex, severe calcification, arch type, previous coronary artery bypass surgery, and primary stenting, suggesting that the contrast volume reflects the complexity of the procedure. Conclusion: The complexity of the procedure and type of stent may play a role in the development of postprocedural hypotension after CAS.

AB - Purpose: To assess the incidence and predictors of severe, persistent postprocedural hypotension (PPH) after carotid artery stenting (CAS). Materials and Methods: A total of 146 patients (mean age 72.8 years; 104 men) who underwent 160 CAS procedures using a standardized protocol at 3 vascular centers were retrospectively analyzed. The primary endpoint was postprocedural hypotension, defined as a reduction in systolic blood pressure (SBP) >40 mm Hg from baseline or an SBP of <90 mm Hg sustained for >1 hour after CAS. Potential prognostic factors for postprocedural hypotension were identified and subjected to logistic regression analyses; outcomes are presented as the odds ratios (ORs) with 95% confidence intervals (CIs). Results: PPH developed in 36 (24.7%) patients after 37 (23.1%) CAS procedures. These patients had significantly longer intensive care unit and hospital stays than those who did not develop hypotension (p<0.001). PPH was associated with severe lesion calcification (OR 6.28, 95% CI 1.81 to 21.98, p=0.004) and contrast volume (OR 1.02, 95% CI 1.01 to 1.02, p<0.001). A 4-fold increase in the risk of PPH (OR 4.22, 95% CI 1.38 to 13.33, p=0.012) was found between the embolic protection device most associated with PPH (Angioguard) and the device least associated with PPH (Emboshield NAV6). A similar trend was also observed for the Precise vs Xact stents (OR 6, 95% CI 2.08 to 17.6, p=0.001). Bootstrapped multivariable modeling identified the Precise stent and contrast volume as significant predictors of persistent postprocedural hypotension. Further investigation of the contrast volume revealed associations with sex, severe calcification, arch type, previous coronary artery bypass surgery, and primary stenting, suggesting that the contrast volume reflects the complexity of the procedure. Conclusion: The complexity of the procedure and type of stent may play a role in the development of postprocedural hypotension after CAS.

KW - calcification

KW - carotid artery stenting

KW - contrast medium

KW - postprocedural hypotension

KW - risk factors

KW - stenosis

KW - stent model

UR - http://www.scopus.com/inward/record.url?scp=85071523044&partnerID=8YFLogxK

U2 - 10.1177/1526602819869929

DO - 10.1177/1526602819869929

M3 - Article

JO - Journal of Endovascular Therapy

JF - Journal of Endovascular Therapy

SN - 1074-6218

ER -