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Liu X, Pan B, Zhang Y, Deng X, Liu X, Chen K, Du L, Yang Y, Yang K. Risk factors for hemodynamic depression after carotid artery stenting: A system review and meta analysis. J Stroke Cerebrovasc Dis 2025; 34:108340. [PMID: 40339731 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 05/03/2025] [Accepted: 05/05/2025] [Indexed: 05/10/2025] Open
Abstract
PURPOSE Hemodynamic depression (HD) regularly occurs during carotid artery stenting(CAS) for treating carotid stenosis and it could result in adverse clinical events. This review aimed to clarify the incidence and risk factors for HD. METHODS We searched four comprehensive databases for studies that reported the incidence or risk factors for HD during CAS. We used a modified version of Newcastle-Ottawa scale to assess the risk of bias in the included studies. We pooled the prevalence rates of HD and related risk factors from individual studies with a generic inverse variance weighted using the randomized effects model. We reported the results using OR with 95 % CI. Funnel plots and Egger's tests were used to assess the publication bias. RESULTS Our meta-analysis enrolled 53 articles and revealed that the incidence of HD was 35 %. Patients who had diabetes (OR = 1.28, 95 % CI: 1.07 to 1.54), stenosis-to-bifurcation <10 mm (OR = 2.11, 95 % CI: 1.29 to 3.48), stenosis involving the carotid bulb (OR = 1.9, 95 % CI: 1.07 to 3.38), calcified plaque (OR = 2.06, 95 % CI: 1.32 to 3.22), eccentric plaque (OR = 1.47, 95 % CI: 1.05 to 2.05), severe stenosis (OR = 1.64, 95 % CI: 1.1 to 2.43), contralateral stenosis (OR = 2.02, 95 % CI: 1.18 to 3.46), open-cell stents (OR = 1.5, 95 % CI: 1.04 to 2.15), and bilateral stenting (OR = 2.32, 95 % CI: 1.56 to 3.44) showed a higher risk of HD. CONCLUSIONS Diabetes, stenosis-to-bifurcation <10 mm, stenosis involving the carotid bulb, calcified plaque, eccentric plaque, severe stenosis, contralateral stenosis, open-cell stents, and bilateral carotid stenting were associated with HD during CAS.
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Affiliation(s)
- Xiaowei Liu
- The First school of Clinical Medicine, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Bei Pan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yunsen Zhang
- Department of Neurosurgery, second people's hospital of Chengdu, Chengdu, China
| | - Xiyuan Deng
- The First school of Clinical Medicine, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xin Liu
- Department of orthopedics, Chengdu second people's hospital, Chengdu, China
| | - Keyu Chen
- Department of Neurosurgery, second people's hospital of Chengdu, Chengdu, China
| | - Liu Du
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yongxiu Yang
- The First school of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
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Liu X, Zheng P, Xu X, Tu Y. Persistent Hemodynamic Depression After Carotid Artery Stenting: A Review and Update. Vasc Endovascular Surg 2022; 56:15385744221096220. [PMID: 35549604 DOI: 10.1177/15385744221096220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to the American Heart Association, ischemic stroke is the second leading cause of death globally and is responsible for approximately 11% of deaths. Carotid endarterectomy (CEA) is the standard treatment for moderate or severe extracranial internal carotid artery (ICA) stenoses. With the development of materials and technology in neurointervention, the Centers for Medicare and Medicaid Services (CMS) have proposed that carotid artery stenting (CAS) can serve as an alternative treatment for CEA. As CAS is widely used worldwide, comorbidities, especially persistent hemodynamic depression (PHD) and stroke, have attracted public attention. In this review, we summarized the current advances in PHD after CAS. A better understanding of CAS-related PHD may inspire the design of potential prognostic and therapeutic tools.
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Affiliation(s)
- Xiaowei Liu
- Department of Neurosurgery, 117852Chengdu Second People's Hospital, Chengdu, China
| | - Peilin Zheng
- The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, 12387Shenzhen People's Hospital, Shenzhen, China
| | - Xuejun Xu
- Department of Neurosurgery, 117852Chengdu Second People's Hospital, Chengdu, China
| | - Yiting Tu
- Department of Neurology, 560852Shenzhen Samii International Medical Center (The Fourth People's Hospital of Shenzhen), Shenzhen, China
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