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(Stroke. 2003;34:2581.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Hypotension After Carotid Revascularization

Cardiovascular Research Foundation, Lenox Hill Heart & Vascular Institute of New York, New York, NY

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Carotid artery stenosis typically involves accumulation of hard calcified atheroma at the common carotid artery bifurcation with involvement of the origin of the internal carotid artery. Anatomically, this location is in close proximity to the area where the carotid baroreceptors are located. The function of these receptors is to sense the tension exerted on the arterial wall and provide feedback control to blood pressure regulation centers.

In patients with carotid artery stenosis requiring revascularization, the mere presence of calcified atheroma in this specific arterial location has chronically sensitized the carotid baroreceptors to very small changes in carotid artery tension. (The thicker and more calcified the wall, the more rapid and efficient pressure/energy transmission it allows.) Therefore, external manipulation of this area during surgery, as well as the transmission of the luminal distention through the arterial wall during balloon inflation and stent expansion, can produce a hypotensive response. This phenomenon varies with (1) the intensity of manipulation or distention of the artery and (2) plaque burden and plaque composition (thickness and calcification).

Development of significant hypotension has been linked with neurological complications after carotid stent procedures.^1,2 Persistent profound hypotension was defined as a >40 mm Hg decrease in arterial pressure without evidence of hypovolemia, with a systolic pressure <90 mm Hg at the end of the procedure and lasting at least 1 hour¹; in the other study, severe hypotension was defined as a pressure drop of at least 50 mm Hg.² Lower levels of hypotension were inconsequential in relation to the patient’s neurological status.

This phenomenon . . . [Full Text of this Article]