Carotid barorecptor related hypotension and bradycardia is more common with Protege carotid stent than Acculink carotid stent
Presenter
Sanjiv Sharma, MD, FACC, FSCAI, Bakersfield Heart Hospital, Bakersfield, CA
Sanjiv Sharma, MD, FACC, FSCAI1, Rohan Sharma, BS2, Neil Bhambi, MD3, Joel Lardizabal, M.D., FSCAI4 and Brijesh K. K Bhambi, M.D.1, (1)Bakersfield Heart Hospital, Bakersfield, CA, (2)Cedars-Sinai Medical Center, Los Angeles, CA, (3)Kaiser Sunset Medical Center, Los Angeles, CA, (4)Central Cardiology SLO, Pismo Beach, CA
Keywords: Carotid/TCAR, Complications and Peripheral Artery Disease (PAD)
Background:
Carotid stent intervention often leads to bradycardia and hypotension due to stretch of the carotid body baroreceptor located in the region of the carotid bulb.
Materials and
Methods:
We compared incidence of bradycardia (heart rate < 40/min) and hypotension (systolic blood pressure < 80 mm Hg) necessitating administration of intravenous atropine (1-2 mg boluses), phenylephrine (50-100 mcg boluses), dopamine infusion and/or oral midodrine (10 mg three times a day) after deployment of carotid stent for severe symptomatic carotid stenosis among two different cohorts who were treated with Acculink (Abbott) carotid stent and Protégé (Medtronic) carotid stent.
Results:
A total of 320 patients were treated with Acculink (Abbott) carotid stent and 44 patients with Protégé (Medtronic) carotid stent. The incidence of hypotension was 15% (n=48) with the Acculink stent and 86% (n=38) with the Protégé stent (p<0.001). Bradycardia occurred in 18 % (n=57) of patients treated with Acculink and 77% (n=34) with Protégé stent (p<0.001). The mean duration of hypotension requiring treatment intravenous dopamine was 0.5+/-0.5 day with Acculink and 1.5+/-2 days with Protégé stent.The risk of peri-procedural cerebrovascular accident or TIA was statistically non-significant (Acculink, n=4, Protege n=0) (p=1, ns).
Conclusions:
Protégé stent appears to have a higher incidence of bradycardia and hypotension as compared with Acculink stent. We hypothesize that this reflects a greater degree of radial strength in the Protégé stent causing higher radial expansion and henceforth greater carotid baroreceptor activation triggering the baroreceptor reflex leading to hypotensive-bradycardic response.