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Bianchi P., Nano G., Casana R., Ramponi F., Malacrida G., Tealdi D. G.
Department of Vascular Surgery IRCCS Policlinico San Donato San Donato Milanese, University of Milan, Milan, Italy
Hypertension, hypotension and bradycardia are well-known complications during and after both carotid endarterectomy and carotid artery stenting (CAS) and are due to carotid sinus stimulation which fires vagal responses and inhibits sympathetic activities. Incidence ranges from 29% to 51% in patients undergoing CAS, and hypotension represents the most frequent and important for its clinical implications. It may be acute or persistent, resolve spontaneously or need medical treatment and contribute to neurological and cardiac adverse events. So, it must be recognized and promptly treated. Different measures included prophylactic placement of temporary venous pacemakers, intravenous atropine at onset of bradycardia or prior carotid distension, vasopressor therapy. Unfortunately, no randomized trials are currently available to verify the efficacy of these medical approaches. There are few reports in literature concerning predictors of hypotension during and after CAS, and results are extremely disomogeneous. Who reported about this issue always considered as primary end-point the identification of predicting factors by evaluation of demographics, clinical history, anatomical and technical features: stent-typology is one of the many variables evaluated in searching a relationship with hypotension. After reviewing literature, there are no authors who primarily analyse that relationship. Significant relationship between stent-type and postprocedural hypotension emerges only in one report after use of balloon-expandable stents, nowadays replaced by self-expanding stent in CAS; so, such observation has not influences on stent’s choice today. The last conclusion is that till now no reports have identified a significant relationship between hypotension after CAS and stent-typology nowadays dedicated to carotid disease.