General Anesthesia is Associated with Hypotension and Prolonged Length of Stay after Carotid Stent: A Vascular Quality Initiative Institutional Analysis.

BACKGROUND

Carotid artery stenting (CAS) is an alternative treatment to carotid endarterectomy for carotid artery stenosis. A common perioperative complication after carotid stent is hemodynamic instability, particularly bradycardia and persistent postprocedural hypotension (PPH). This study aims to identify the demographic characteristics and periprocedural factors associated with PPH in patients undergoing CAS in our practice.

METHODS

A retrospective review of patients who underwent CAS within our healthcare network from January 2017 to December 2024 was conducted with our institutional Vascular Quality Initiative database. Adult patients that had elective CAS procedures, including transcarotid artery revascularization (TCAR) or transfemoral-CAS, were included. Emergent or urgent interventions were excluded. Collected data included demographic characteristics, intraoperative variables, postoperative outcomes, and complications. The primary outcomes were admission to intensive care unit (ICU) and PPH (systolic blood pressure <100 mm Hg). A multivariable logistic regression analysis was performed to identify independent predictors of the primary outcomes.

RESULTS

A total of 233 patients (236 CAS) with a mean age of 73.5 ± 7.2 years were found eligible for final analysis. Of the 236 procedures, 163 TCAR (69.1%), and 73 transfemoral CAS (30.9%) were performed. Hypotension after carotid stent was recorded in 122 cases (51.7%), of whom 85 patients (69.7%) were managed with oral medications, and 69 (56.6%) required intravenous vasopressor support. Sixty-three patients (51.6% of patients with PPH) required ICU admission and stay. Mortality at 1 year was 3.0% (n = 7). Multivariable logistic regression identified male sex (P = 0.03) and diabetes (P = 0.003) as protective factors against PPH. The use of general anesthesia was a significant risk factor for both PPH (P = 0.03) and ICU stay (P = 0.04).

CONCLUSION

Hypotension after carotid stenting is a frequent and transient phenomenon. In our study, the use of general anesthesia was significantly associated with PPH and ICU admission, while diabetes and male sex had a protective effect against PPH.