Hemodynamic instability during carotid angioplasty and stenting-relationship of calcified plaque and its characteristics

Abstract

Purpose: During carotid angioplasty and stenting (CAS), hemodynamic instability (HDI) can occur, possibly causing post-procedural ischemic complications. The goal of this study was to investigate the risk factors of HDI focusing on characteristics of plaque.

Materials and methods: Thirty nine CAS patients were retrospectively evaluated for HDI. Prolonged HDI that lasted over 30 minutes was analyzed in relation to characteristics of calcified plaque.

Results: Nineteen (48.7%) patients had HDI. Ten of the 19 had both bradycardia and hypotension, and nine had only bradycardia. All bradycardia was treated well with a transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension in spite of recovery of bradycardia. Calcified plaque was a related factor associated with HDI (odds ratio, 8.571; 95% confidence interval, 1.321-55.62; p=0.024). Extensive and eccentric type calcified plaques were associated with prolonged hypotension (p=0.04, and p=0.028, respectively).

Conclusion: The calcification of plaque is a predictable factor of HDI during CAS, and its extensive and eccentric calcified plaques may be related to prolonged HDI.

Fig. 1

The classification of plaque on distribution of longitudinal image. (a) Extensive plaque located from CCA to ICA within 5 mm from bifurcation (arrow) on both sides. (b) Proximal plaque included ICA within 5 mm from bifurcation. (c) Distal plaque included ICA beyond 5 mm from bifurcation. CCA, common carotid artery; ICA, internal carotid artery.

Fig. 2

Carotid CT and Dyna-CT show the classification of calcified plaque on distribution of cross-sectional image. (A) Eccentric calcified plaque. (B) Concentric calcified plaque.