Background Persistent hypotension (PH) after carotid artery stenting (CAS) is a relatively common complication; however, it is unclear which patients are more likely to experience this phenomenon. Recently, lower left atrial (LA) volume was associated with vasovagal syncope, which has a similar neurological mechanism to hypotension after CAS. This study aimed to investigate whether LA volume can predict PH after CAS.
Methods This single center retrospective analysis used data from 316 patients who had undergone CAS between March 2013 and February 2021. After the exclusion of urgent CAS, 212 procedures (202 patients) with transthoracic echocardiograms were included. The procedures were divided among two groups according to the presence or absence of PH for more than 1 hour after CAS.
Results The mean age of the patients was 73.0±7.5 years. PH was observed during 52 (24.5%) procedures. The PH group exhibited a lower LA volume index (LAVI) than the no-PH group (29.7±9.1 vs 37.7±12.5 mL/m2, respectively; p<0.001). The area under the receiver operating characteristic curve was 0.716. The optimal cut-off value was 33.5 mL/m2 (sensitivity 0.750, specificity 0.625). Multiple logistic regression analysis showed that LAVI <33.5 mL/m2 was an independent predictor for PH after CAS (OR 4.950, 95% CI 2.190 to 11.200; p<0.001). Preoperative hydration was negatively associated with PH (OR 0.235, 95% CI, 0.070 to 0.794; p=0.020).
Conclusions A lower LA volume can predict PH after CAS, and preoperative hydration may prevent PH after CAS.
- Blood Pressure
Data availability statement
Data are available upon reasonable request.
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Contributors KM is responsible for the overall content as guarantor. KM substantially contributed to the study conceptualization, acquisition of the data, analysis and interpretation of data, and drafting of the manuscript. NO substantially contributed to the study conceptualization, analysis and interpretation of data, and drafting of the manuscript. JT substantially contributed to analysis and interpretation of data, and drafting of the manuscript. TO and CM contributed to the analysis and interpretation of data and drafting of the manuscript. HI significantly contributed to acquisition of data. NS and others contributed to revising the manuscript critically for important intellectual content. All authors approved the final version of the manuscript to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests HI received speakers’ bureau/honoraria from Medtronic Japan Co, Daiichi Sankyo Co, Johnson & Johnson Co, Stryker Japan Co, Terumo Co, and Asahi Intecc Co. NS reports a research grant from Biomedical Solutions Co, Medtronic Co and Terumo Co; lecturer’s fees from Asahi-Intec Co, Biomedical Solutions Co, Medtronic Co, and Terumo Co; membership on the advisory boards for Johnson & Johnson Co, Medtronic Co and Terumo Co outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.
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