ORIGINAL ARTICLE  CAROTID DISEASE Free access

International Angiology 2020 February;39(1):17-23

DOI: 10.23736/S0392-9590.19.04294-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Is there any relationship between carotid bifurcation geometry and hemodynamic depression after carotid stenting and angioplasty?

Yilmaz ONAL ¹ ✉, Cesur SAMANCI ²

¹ Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey; ² Department of Radiology, Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Istanbul, Turkey

BACKGROUND: Hemodynamic depression (HD) is a condition that can be encountered after carotid stenting (CAS) and carotid angioplasty (CAP) due to manipulation of the carotid sinus. The aim of this study was to evaluate whether the carotid bifurcation geometry and angles, or changes in angles, were associated with this HD in patients undergoing CAS and CAP.
METHODS: Sixty-two patients with a mean age of 71.1±7.4 years, who underwent CAS and CAP for carotid stenosis were included in the study. HD was defined as periprocedural hypotension (systolic blood pressure <90 mmHg) or bradycardia (heart rate <60 bpm). The effect of carotid bifurcation geometry, plaque morphology and risk factors on subsequent development of HD was analyzed with binary logistic regression models. ICA-CCA angle was measured from digital subtraction angiographies (DSA) before and after stent deployment by two radiologists. Interobserver agreement was calculated.
RESULTS: Periprocedural HD was seen in 22 (35.5%) patients. Extension of carotid lesion to bulbus, preoperative internal carotid artery (ICA) angle, postoperative angular changes, pre-op systolic blood pressure, balloon-to-artery ratio and HD were significantly correlated. A significant difference was observed between the angle of ICA before and after the procedure between the patients with HD and those without HD.
CONCLUSIONS: Carotid anatomy and geometry may enhance the risk of HD independent of other factors and may be of help in very early identification of patients at high risk of developing HD after CAS and CAP.

KEY WORDS: Carotid stenosis; Hemodynamics; Angioplasty