| Part ?:Acute Effect of Carotid Artery Stenting on HemodynamicsBackground and Objective:Hemodynamic instability(HI)is a common phenomenon after carotid artery stenting(CAS),but there are still existing significant controversies regarding incidence,predictors,and clinical significance of HI after CAS.The purpose of this study was to investigate the acute effect of CAS on hemodynamics.Methods:The perioperative data of consecutive 170 patients underwent CAS from September 2014 to September 2015 were retrospectively analyzed in our institution.The acute effects of proximal internal carotid artery stenting on blood pressure and heart rate were investigated and patients were followed up for 1 month to observe its relationship with perioperative adverse events.Results:(1)Compared with preoperative level,all day average systolic blood pressure decreased from 126.6 ± 15.1(93-175)mmHg to 117.7 ± 13.7(87-158)mmHg(P?0.01),all day average diastolic blood pressure 72.8 ± 11.5(49-100)mmHg to 67.3 ± 10.3(48-90)mmHg(P<0.01),and all day average heart rate 66.3 ± 6.8(49-84)bpm to 62.6 ± 7.2(49-88)bpm(P<0.01).(2)The incidence of HI was 51.8%(88/170),among which the incidence of hypertension,hypotension and bradycardia was 3.5%(6/170),39.4%(67/170)and 22.4%(38/170),respectively.Multivariate regression analysis showed that the occurrence of HI was closely related to gender,history of hypertension,bilateral CAS and carotid bifurcation lesions.After the onset of HI,blood pressure and heart rate can be restored to normal levels by intravenous infusion of vasoactive drugs in all patients,of which 6 cases(3.5%)were administrated for more than 24 hours.(3)A total of 8 patients(4.7%)experienced adverse events during the perioperative period,including 4 patients with transient ischemic attack,2 patients with minor stroke and 2 patients with major stroke(1 patient died).The proportion of adverse events in the hemodynamic stability(HS)group was 2.4%(2/82)and the proportion of HI group was 6.8%(P= 0.32).Among HI group,the incidence of adverse events in patients with hypertension,hypotension,bradycardia and hypotension combined with bradycardia was 16.7%(1/6),6.6%(3/48),0%(0/19)and 10.5%(2/19),respectively(P =0.491,P=0.537,P=0.359 and P=0.329,respectively).Conclusions:The incidence of HI during the perioperative period is frequent,gender,history of hypertension,bilateral CAS and carotid bifurcation lesions are its independent predictors,and the use of vasoactive drugs timely and reasonably is significantly important for the prevention or reduction of HI associated adverse events.Part ?:Hemodynamic Depression on the Incidence of contrast-induced acute kidney injury after Carotid Artery Stenting.Background and Objective:Currently,the studies related to contrast-induced acute kidney injury(CI-AKI)are mainly focused on coronary angiography.Similar data,however,are lacking in patients undergoing peripheral angiography,especially in patients with carotid interventional therapy.Hemodynamic depression(HD)is a very common phenomenon after carotid artery stenting(CAS),including hypotension and bradycardia.Considering that the occurrence of HD will reduce the renal perfusion,it may increase the nephrotoxicity of the contrast agent to the kidney.The main purpose of the present study was to investigate the effect of hemodynamic depression(HD)on the incidence of CI-AKI after carotid artery stenting.Methods:A total of 262 patients with proximal internal carotid artery stenting were prospectively enrolled in our hospital between March 2014 and September 2015.The perioperative clinical data of the patients(preoperative and postoperative blood pressure,heart rate and serum creatinine levels,etc.)were collected to observe the effect of HD on the incidence of CI-AKI.Patients were followed up for 1 month to observe its relationship between CI-AKI and perioperative adverse events.Results:(1)The overall incidence of CI-AKI was 18.7%(49/262).(2)The incidence of HD was 51.5%(135/262),with a significant difference in the incidence of CI-AKI between the HD group(n=135)and non-HD group(n=127)groups[23.7%(32/135)]vs 13.4%(17/127);P=0.04].The maxASCr in the HD group was also higher than that in the non-HD group(13.7±19.3 vs 7.6±15.6 ml/min*1.73 m2,P=0.005).(3)The duration of HD has a significant relationship with the incidence of CI-AKI.With the prolongation of HD duration,the incidence of CI-AKI is increasing.(4)Subgroup analysis of patients with different types of HD found that patients with postoperative systolic blood pressure<90 mmHg,heart rate<60 beats/min,and hypotension with bradycardia were prone to CI-AKI(P<0.05).(4)A total of 11 patients(4.2%)experienced adverse events during the perioperative period[5 transient ischemic attacks,4 strokes,1 death(one patient in the CI-AKI group died of hemorrhagic stroke),1 myocardial infarction,and 1 doubling of SCr].Patients in the CI-AKI group had a higher rate of adverse events compared with the non-CI-AKI group[8.2%(4/49)vs 3.3%(7/213);p=0.254].Conclusions:Patients with HD after carotid artery stenting are more likely to develop CI-AKI,especially in patients with persistent HD,and CI-AKI may increase the incidence of adverse events. |
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