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Haghighi AB, Kokabi S, Yousefi S, Emami M, Shariat A, Nikseresht A, Ashjazadeh N, Izadi S, Petramfar P, Poursadegh M, Jaberi AR, Emami S, Agheli H, Nemati R, Yaghoubi E, Kashani K, Panahandeh M, Heidari-Khormizi SM, Cruz-Flores S, Edgell R. The Prevalence and Factors Contributing to Hemodynamic Depression in Patients Undergoing Carotid Angioplasty and Stenting. J Vasc Interv Neurol 2015; 8:5-10. [PMID: 26600923 PMCID: PMC4634774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hemodynamic depression, including bradycardia and hypotension, is among the most common complications of carotid angioplasty and stenting. METHODS AND MATERIAL A prospective, cross-sectional study was conducted at Shiraz University of Medical Sciences in southern Iran from 2011 to 2013. Consecutive patients undergoing carotid angioplasty and stenting were included. Demographic data, atherosclerotic risk factors, preprocedural blood pressure, the site of stenosis, the degree of stenosis, and data regarding technical factors were recorded. Hemodynamic depression was defined as a systolic blood pressure less than 90 mmHg and/or heart rate less than 50 beat/min. RESULTS About 170 patients (67% male, mean age: 71+9.8, 55.9% right side, 82.9% symptomatic) were recruited. Mean degree of stenosis was 79.4% in operated side and 40.7% in nonoperated side. Predilation, postdilation, or both were conducted in 18(10.5%), 141(83%), 11(6.5%) patients respectively. Thirteen (7.6%), 41(24%), and 12(7%) of patients developed postprocedural bradycardia, hypotension or both, respectively. Two patients had a stroke after CAS and periprocedural mortality was 0%. Hemodynamic depression after CAS had a significant association with preprocedure blood pressure and the use of an open cell stent design, but not with atherosclerotic risk factors, site and/or degree of stenosis, predilation, or postdilation. Hemodynamic depression significantly increased hospital stay too. CONCLUSION Preprocedural hydration and close-cell stents may decrease the risk of poststenting hemodynamic depression.
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Affiliation(s)
- Afshin Borhani Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Safoora Kokabi
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Yousefi
- Non communicable diseases research center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mehrdad Emami
- Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolhamid Shariat
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Nikseresht
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Poursadegh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimi Jaberi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Departments of Neurolog,y, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajjad Emami
- Department of Neurology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Hamid Agheli
- Neurologist, Shahidzadeh Hospital, Behbahan, Iran
| | - Reza Nemati
- Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ehsan Yaghoubi
- Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Kaveh Kashani
- Department of Neurology, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | | | | | | | - Randal Edgell
- Departments of Neurology and Psychiatry, Saint Louis University, Saint Louis, MO, USA
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Borhani Haghighi A, Yousefi S, Bahramali E, Kokabi S, Heydari ST, Shariat A, Nikseresht A, Ashjazadeh N, Izadi S, Petramfar P, Poursadegh M, Rahimi Jaberi A, Emami S, Agheli H, Nemati R, Yaghoubi E, Abdi MH, Panahandeh M, Heydari M, Safari A, Basir M, Cruz-Flores S, Edgell R. Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting. Interv Neurol 2015; 3:165-73. [PMID: 26279663 DOI: 10.1159/000430923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. MATERIALS AND METHODS This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. Thirty-day stroke, myocardial infarction, and/or death were considered as the composite primary outcomes of the study. RESULTS A total of 251 patients were recruited (mean age: 71.1 ± 9.6 years; male: 65.3%). Of these, 178 (70.9%) were symptomatic, 73 (29.1%) were diabetic, 129 (51.4%) were hyperlipidemic, 165 (65.7%) were hypertensive, and 62 (24.7%) patients were smokers. CAS was performed for left internal carotid artery (ICA) in 113 (45.4%) patients. Fourteen (5.6%) patients had sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 ± 13.8%. An embolic protection device was used in 203 (96.2%) patients. Pre- and postdilation were performed in 39 (18.5%) and 182 (86.3%) patients, respectively. Composite outcomes were observed in 3.6% of patients (3.2% stroke, 0% myocardial infarction, and 1.2% death). Left-sided lesions and the presence of diabetes mellitus were significantly associated with poor short-term outcome (p = 0.025 and p = 0.020, respectively). CONCLUSION There was a higher risk of short-term major complications in diabetic patients and for left carotid artery intervention.
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Affiliation(s)
- Afshin Borhani Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Samaneh Yousefi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ehsan Bahramali
- Cardiology Department, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Safoora Kokabi
- Transgenic Technology Research Center, Shiraz University of Medical Sciences, Fasa, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Fasa, Iran
| | - Abdolhamid Shariat
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Alireza Nikseresht
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Maryam Poursadegh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Abbas Rahimi Jaberi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Fasa, Iran ; Department of Neurology, Shiraz University of Medical Sciences, Fasa, Iran
| | - Sajjad Emami
- Department of Neurology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Hamid Agheli
- Shahidzadeh Hospital, Behbahan, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Nemati
- Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ehsan Yaghoubi
- Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammad Hosein Abdi
- Motaharri Hospital, Marvdasht, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Majid Panahandeh
- Ordibehesht Hospital, Shiraz, Fasa University of Medical Sciences, Fasa, Iran
| | - Moslem Heydari
- Department of Neurology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Anahid Safari
- Department of Pharmacology, Kazeroon Azad University, Kazeroon, Iran
| | - Marziyeh Basir
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Randal Edgell
- Department of Neurology, Saint Louis University, Saint Louis, Mo., USA ; Department of Psychiatry, Saint Louis University, Saint Louis, Mo., USA
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