Risk Factors for Hemodynamic Depression After Carotid Stenting

The effects of different stents and morphology of the stenosis on hemodynamic depression (HD) and in-stent restenosis (ISR) are unclear after carotid artery stenting(CAS). 142 patients were retrospectively enrolled and stratified into straight stent(SS) and tapered stent(TS), and further stratified according to stenosis morphology to compare the differences in final events. Logistic analysis was used to determine the risk factors for the occurrence of HD. TS had a lower incidence of post-procedural HD (38.8% vs 60.0%, P=0.012) and 1-year ISR (1.5% vs 8.0%, P=0.078). In centripetal stenosis, there was no significant difference in post-procedural HD between the different stents(27.3% vs 47.8%, P=0.155). In contrast, for eccentric stenosis, TS was associated with a reduced risk of post-procedural HD (42.2% vs 67.3%, P=0.013). Logistic analyses found that eccentric stenosis (OR=2.561, 95%CI=1.100-5.965, P=0.029), high-echo plaque (OR=5.877, 95%CI=1.472-23.462, P=0.012), open-cell stent (OR=3.173, 95%CI=1.067-9.436, P=0.038), and distal diameter of stent (OR=1.541, 95%CI=1.104-2.153, P=0.011) were risk factors for post-procedural HD. The following factors were identified as risk factors for persistent hemodynamic depression(PHD): high-echo plaque (OR=7.605, 95%CI=2.105-27.468, P=0.002) and open-cell stent(OR=7.017, 95%CI=1.384-35.583, P=0.019), additionally, the further the minimum lumen diameter is removed from the carotid bifurcation, the lower the risk of PHD (OR=0.942, 95%CI=0.894-0.992, P=0.024). TS reduces the risk of post-operative HD and there was a trend toward a lower risk of ISR at 1 year after the procedure. Eccentric stenosis, high-echo plaque, open-cell stent, and distal diameter of stent are high risk factors for HD.