Purpose of study During carotid artery stenting (CAS) under local anesthesia, hemodynamic instability (hypotension, bradycardia, etc) has been reported to occur. Hemodynamic instability during CAS under local anesthesia, especially in elderly patients, may be a risk factor for complications.

We evaluate the hemodynamic stability during CAS under general anesthesia in elderly patients with a high grade carotid artery stenosis.

Methods 15 CAS procedures were performed under general anesthesia using sevoflurane and nitrous oxide in oxygen in in 15 patients aged 65 years or older between November 2007 and February 2009. All CAS procedures were performed for high grade stenoses (>70% in NASCET criteria). Nine procedures were performed for symptomatic stenoses. Degree of systolic blood pressure change, hypotension and bradycardia during CAS were assessed.

Results Mean age of patients was 69±3.2 years. Mean degrees of stenosis before and after CAS was 75.8±7.5% and 25.9±9.8%, respectively. No hypotension (systolic blood pressure <80 mm Hg) occurred during procedures, and transient bradycardia (heart rate <50/min) occurred in one patient (0.6%) during the procedures. Mean systolic blood pressure change was 35±11.9 mm Hg. No procedure was complicated by stroke during or after CAS.

Conclusion General anesthesia using sevoflurane and nitrous oxide in oxygen depressed baroreceptor reflex sensitivity, induced hemodynamic stability during CAS and may decrease the rate of occurrence of complications in elderly patients with a high grade carotid artery stenosis.