The effect of ballooning following carotid stent deployment on hemodynamic stability

Umair Qazi, Tammam E. Obeid, Ngozi Enwerem, Eric Schneider, Jessica R. White, Julie A. Freischlag, Bruce A. Perler, Mahmoud B. Malas

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective While patient eligibility for carotid artery stenting (CAS) is well established, the intraoperative technique remains widely varied. The decision to perform poststent ballooning (PSB) is operator-dependent and often influenced by the interpretation of poststent angiography. While visually creating a greater luminal diameter, it is unclear whether PSB has immediate risks or long-term benefits. The purpose of this report is to determine whether PSB has any effects on periprocedural hemodynamic stability. Methods A retrospective analysis of all patients that underwent CAS between 2005 and 2012 at a tertiary care center was performed. The primary end point was hemodynamic instability, defined as bradycardia (a heart rate of <60 beats/min) or hypotension (systolic blood pressure of <90 mm Hg) during the intraoperative or postoperative period. Binary logistic regression model was performed to determine the effect of PSB on the occurrence of hemodynamic instability, adjusting for patient's age, sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, recent myocardial infarction, previous carotid endarterectomy, high-risk status, and symptomatic status. Results A total of 103 (51 men and 52 women) patients underwent placement of a unilateral carotid stent between 2005 and 2012 at our institution. All patients underwent prestent dilatation. However, 70% (n = 72) underwent PSB whereas 30% (n = 31) did not. PSB was a significant predictor of hemodynamic depression (odds ratio [OR], 3.8; 95% confidence interval, 1.3-11; P <.01). Symptomatic status, recent myocardial infarction, hyperlipidemia, and coronary artery disease were associated with a length of stay exceeding 24 hours postoperatively (OR, 6.6; P <.01, OR, 6.1; P <.01, OR, 5.4; P =.04, and OR, 9.3; P <.01, respectively). At follow-up, 97% (83/86) stents were patent. Two stent stenoses occurred in the group that received PSB, while one stent stenosis occurred in the group that did not receive PSB. Conclusions PSB increases the risk of intra- or postoperative hemodynamic depression in CAS and might increase the risk of major adverse cardiovascular events. Given the added complications and the lack of evidence supporting long term patency, PSB should be only selectively used.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
Volume59
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

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Stents
Hemodynamics
Odds Ratio
Carotid Arteries
Hyperlipidemias
Coronary Artery Disease
Pathologic Constriction
Logistic Models
Intraoperative Period
Myocardial Infarction
Blood Pressure
Carotid Endarterectomy
Bradycardia
Postoperative Period
Tertiary Care Centers
Hypotension
Dilatation
Length of Stay
Diabetes Mellitus
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Qazi, U., Obeid, T. E., Enwerem, N., Schneider, E., White, J. R., Freischlag, J. A., ... Malas, M. B. (2014). The effect of ballooning following carotid stent deployment on hemodynamic stability. Journal of Vascular Surgery, 59(3). https://doi.org/10.1016/j.jvs.2013.09.027

The effect of ballooning following carotid stent deployment on hemodynamic stability. / Qazi, Umair; Obeid, Tammam E.; Enwerem, Ngozi; Schneider, Eric; White, Jessica R.; Freischlag, Julie A.; Perler, Bruce A.; Malas, Mahmoud B.

In: Journal of Vascular Surgery, Vol. 59, No. 3, 03.2014.

Research output: Contribution to journalArticle

Qazi, U, Obeid, TE, Enwerem, N, Schneider, E, White, JR, Freischlag, JA, Perler, BA & Malas, MB 2014, 'The effect of ballooning following carotid stent deployment on hemodynamic stability', Journal of Vascular Surgery, vol. 59, no. 3. https://doi.org/10.1016/j.jvs.2013.09.027
Qazi, Umair ; Obeid, Tammam E. ; Enwerem, Ngozi ; Schneider, Eric ; White, Jessica R. ; Freischlag, Julie A. ; Perler, Bruce A. ; Malas, Mahmoud B. / The effect of ballooning following carotid stent deployment on hemodynamic stability. In: Journal of Vascular Surgery. 2014 ; Vol. 59, No. 3.
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abstract = "Objective While patient eligibility for carotid artery stenting (CAS) is well established, the intraoperative technique remains widely varied. The decision to perform poststent ballooning (PSB) is operator-dependent and often influenced by the interpretation of poststent angiography. While visually creating a greater luminal diameter, it is unclear whether PSB has immediate risks or long-term benefits. The purpose of this report is to determine whether PSB has any effects on periprocedural hemodynamic stability. Methods A retrospective analysis of all patients that underwent CAS between 2005 and 2012 at a tertiary care center was performed. The primary end point was hemodynamic instability, defined as bradycardia (a heart rate of <60 beats/min) or hypotension (systolic blood pressure of <90 mm Hg) during the intraoperative or postoperative period. Binary logistic regression model was performed to determine the effect of PSB on the occurrence of hemodynamic instability, adjusting for patient's age, sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, recent myocardial infarction, previous carotid endarterectomy, high-risk status, and symptomatic status. Results A total of 103 (51 men and 52 women) patients underwent placement of a unilateral carotid stent between 2005 and 2012 at our institution. All patients underwent prestent dilatation. However, 70{\%} (n = 72) underwent PSB whereas 30{\%} (n = 31) did not. PSB was a significant predictor of hemodynamic depression (odds ratio [OR], 3.8; 95{\%} confidence interval, 1.3-11; P <.01). Symptomatic status, recent myocardial infarction, hyperlipidemia, and coronary artery disease were associated with a length of stay exceeding 24 hours postoperatively (OR, 6.6; P <.01, OR, 6.1; P <.01, OR, 5.4; P =.04, and OR, 9.3; P <.01, respectively). At follow-up, 97{\%} (83/86) stents were patent. Two stent stenoses occurred in the group that received PSB, while one stent stenosis occurred in the group that did not receive PSB. Conclusions PSB increases the risk of intra- or postoperative hemodynamic depression in CAS and might increase the risk of major adverse cardiovascular events. Given the added complications and the lack of evidence supporting long term patency, PSB should be only selectively used.",
author = "Umair Qazi and Obeid, {Tammam E.} and Ngozi Enwerem and Eric Schneider and White, {Jessica R.} and Freischlag, {Julie A.} and Perler, {Bruce A.} and Malas, {Mahmoud B.}",
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AU - Obeid, Tammam E.

AU - Enwerem, Ngozi

AU - Schneider, Eric

AU - White, Jessica R.

AU - Freischlag, Julie A.

AU - Perler, Bruce A.

AU - Malas, Mahmoud B.

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N2 - Objective While patient eligibility for carotid artery stenting (CAS) is well established, the intraoperative technique remains widely varied. The decision to perform poststent ballooning (PSB) is operator-dependent and often influenced by the interpretation of poststent angiography. While visually creating a greater luminal diameter, it is unclear whether PSB has immediate risks or long-term benefits. The purpose of this report is to determine whether PSB has any effects on periprocedural hemodynamic stability. Methods A retrospective analysis of all patients that underwent CAS between 2005 and 2012 at a tertiary care center was performed. The primary end point was hemodynamic instability, defined as bradycardia (a heart rate of <60 beats/min) or hypotension (systolic blood pressure of <90 mm Hg) during the intraoperative or postoperative period. Binary logistic regression model was performed to determine the effect of PSB on the occurrence of hemodynamic instability, adjusting for patient's age, sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, recent myocardial infarction, previous carotid endarterectomy, high-risk status, and symptomatic status. Results A total of 103 (51 men and 52 women) patients underwent placement of a unilateral carotid stent between 2005 and 2012 at our institution. All patients underwent prestent dilatation. However, 70% (n = 72) underwent PSB whereas 30% (n = 31) did not. PSB was a significant predictor of hemodynamic depression (odds ratio [OR], 3.8; 95% confidence interval, 1.3-11; P <.01). Symptomatic status, recent myocardial infarction, hyperlipidemia, and coronary artery disease were associated with a length of stay exceeding 24 hours postoperatively (OR, 6.6; P <.01, OR, 6.1; P <.01, OR, 5.4; P =.04, and OR, 9.3; P <.01, respectively). At follow-up, 97% (83/86) stents were patent. Two stent stenoses occurred in the group that received PSB, while one stent stenosis occurred in the group that did not receive PSB. Conclusions PSB increases the risk of intra- or postoperative hemodynamic depression in CAS and might increase the risk of major adverse cardiovascular events. Given the added complications and the lack of evidence supporting long term patency, PSB should be only selectively used.

AB - Objective While patient eligibility for carotid artery stenting (CAS) is well established, the intraoperative technique remains widely varied. The decision to perform poststent ballooning (PSB) is operator-dependent and often influenced by the interpretation of poststent angiography. While visually creating a greater luminal diameter, it is unclear whether PSB has immediate risks or long-term benefits. The purpose of this report is to determine whether PSB has any effects on periprocedural hemodynamic stability. Methods A retrospective analysis of all patients that underwent CAS between 2005 and 2012 at a tertiary care center was performed. The primary end point was hemodynamic instability, defined as bradycardia (a heart rate of <60 beats/min) or hypotension (systolic blood pressure of <90 mm Hg) during the intraoperative or postoperative period. Binary logistic regression model was performed to determine the effect of PSB on the occurrence of hemodynamic instability, adjusting for patient's age, sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, recent myocardial infarction, previous carotid endarterectomy, high-risk status, and symptomatic status. Results A total of 103 (51 men and 52 women) patients underwent placement of a unilateral carotid stent between 2005 and 2012 at our institution. All patients underwent prestent dilatation. However, 70% (n = 72) underwent PSB whereas 30% (n = 31) did not. PSB was a significant predictor of hemodynamic depression (odds ratio [OR], 3.8; 95% confidence interval, 1.3-11; P <.01). Symptomatic status, recent myocardial infarction, hyperlipidemia, and coronary artery disease were associated with a length of stay exceeding 24 hours postoperatively (OR, 6.6; P <.01, OR, 6.1; P <.01, OR, 5.4; P =.04, and OR, 9.3; P <.01, respectively). At follow-up, 97% (83/86) stents were patent. Two stent stenoses occurred in the group that received PSB, while one stent stenosis occurred in the group that did not receive PSB. Conclusions PSB increases the risk of intra- or postoperative hemodynamic depression in CAS and might increase the risk of major adverse cardiovascular events. Given the added complications and the lack of evidence supporting long term patency, PSB should be only selectively used.

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