Hemodynamic Instability After Carotid Artery Angioplasty and
Hemodynamic Instability After Carotid Artery Angioplasty and
In this review of the literature the goal was to determine the frequency and relevance of hemodynamic instability after carotid artery (CA) angioplasty and stent placement.
Hemodynamic instability after CA angioplasty and stent placement is a well-recognized phenomenon that occurs in 29 to 51% of patients undergoing the procedure. In some patients this problem is severe enough to warrant treatment with vasopressor agents. Features observed on clinical and angiographic evaluation can help clinicians identify patients who are at risk. Hemodynamic fluctuations encountered as a result of CA angioplasty and stent placement may have adverse clinical consequences, including a higher incidence of myocardial infarction and stroke. Proposed measures to prevent this complication include prophylactic placement of transvenous pacemakers or pretreatment with atropine. Unfortunately, no randomized trials are currently available to assess the efficacy of these approaches.
Hemodynamic instability is a common finding after CA angioplasty and stent placement. Clinicians can predict which patients are at risk by considering angiographic and clinical features.
Carotid artery angioplasty and stent placement is increasingly being used as an alternative to CEA, especially in patients considered to be at high surgical risk. Hemodynamic instability due to the manipulation of the CA bulb has been described after CEA, and recent reports detail a similar phenomenon after CA angioplasty and Many of these reports are from single-center case series, but highlight the importance of recognizing and understanding this relatively common phenomenon. It is unclear whether patients who experience hemodynamic lability are at higher risk of adverse outcomes, although this has been asserted in some series and case reports. In addition, researchers at some centers have advocated prophylactic placement of temporary pacemakers, although this practice has not gained widespread acceptance.
We will review the incidence of hemodynamic instability as well as the pathophysiological mechanisms underlying this phenomenon. In addition, we will discuss potential strategies for early identification of patients at high risk of experiencing hemodynamic instability and we will provide insight into prevention and management of this problem.
In this review of the literature the goal was to determine the frequency and relevance of hemodynamic instability after carotid artery (CA) angioplasty and stent placement.
Hemodynamic instability after CA angioplasty and stent placement is a well-recognized phenomenon that occurs in 29 to 51% of patients undergoing the procedure. In some patients this problem is severe enough to warrant treatment with vasopressor agents. Features observed on clinical and angiographic evaluation can help clinicians identify patients who are at risk. Hemodynamic fluctuations encountered as a result of CA angioplasty and stent placement may have adverse clinical consequences, including a higher incidence of myocardial infarction and stroke. Proposed measures to prevent this complication include prophylactic placement of transvenous pacemakers or pretreatment with atropine. Unfortunately, no randomized trials are currently available to assess the efficacy of these approaches.
Hemodynamic instability is a common finding after CA angioplasty and stent placement. Clinicians can predict which patients are at risk by considering angiographic and clinical features.
Carotid artery angioplasty and stent placement is increasingly being used as an alternative to CEA, especially in patients considered to be at high surgical risk. Hemodynamic instability due to the manipulation of the CA bulb has been described after CEA, and recent reports detail a similar phenomenon after CA angioplasty and Many of these reports are from single-center case series, but highlight the importance of recognizing and understanding this relatively common phenomenon. It is unclear whether patients who experience hemodynamic lability are at higher risk of adverse outcomes, although this has been asserted in some series and case reports. In addition, researchers at some centers have advocated prophylactic placement of temporary pacemakers, although this practice has not gained widespread acceptance.
We will review the incidence of hemodynamic instability as well as the pathophysiological mechanisms underlying this phenomenon. In addition, we will discuss potential strategies for early identification of patients at high risk of experiencing hemodynamic instability and we will provide insight into prevention and management of this problem.
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