Carotid artery stenting-induced hemodynamic instability.

Purpose: To present a systematic review and meta-analysis investigating the incidence of carotid artery stenting (CAS)-induced hemodynamic instability (HI) and to explore differences in periprocedural risk among patients with and without CAS-associated HI.

Methods: Multiple electronic health databases were searched for all articles published between January 2000 and December 2011 describing CAS-associated hemodynamic instability. Twenty-seven studies with a total of 4204 patients were analyzed, placing emphasis on the HI incidence and its correlation with postprocedure morbidity and mortality. A meta-regression analysis was conducted to investigate the role of potential meaningful modifiers upon HI.

Results: The meta-analysis for overall HI rate showed a pooled proportion of 39.4%. The pooled estimate for hypotension was 12.1%, 12.2% for bradycardia, and 12.5% for both hypotension and bradycardia. Persistent HI was found to occur in a pooled rate of 19.2%. No statistically significant differences were found between patients with and without HI after CAS with respect to death, stroke, transient ischemic attack (TIA), or major adverse events. The meta-regression analysis revealed statistically significant associations of mean age with HI, of ≤10-mm distance between the carotid bifurcation and the site of minimum lumen diameter with bradycardia, and of prior ipsilateral CEA with persistent HI.

Conclusion: CAS-induced HI occurs in a considerable percentage of patients without increasing the perioperative risk. However, applying the appropriate prophylactic measures and strictly monitoring blood pressure and heart rate during the procedure and immediately after should be encouraged for early recognition and correction of these hemodynamic disturbances.