Risk Factors for Hemodynamic Depression After Carotid Stenting

Yaoliang Wang; Wei Liu; Yile Zhang; Ke Mou; Weizhong Wang; Xiaodong Shao; Qianliang Wang; Lin Yang; Qingdong Guo

doi:10.1016/j.wneu.2025.123790

Risk Factors for Hemodynamic Depression After Carotid Stenting

World Neurosurg. 2025 Mar 12:196:123790. doi: 10.1016/j.wneu.2025.123790. Online ahead of print.

Authors

Yaoliang Wang¹, Wei Liu¹, Yile Zhang¹, Ke Mou², Weizhong Wang¹, Xiaodong Shao¹, Qianliang Wang¹, Lin Yang³, Qingdong Guo⁴

Affiliations

¹ Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
² Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
³ Department of Vascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
⁴ Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China. Electronic address: guoqd1991@sina.cn.

PMID: 39955052
DOI: 10.1016/j.wneu.2025.123790

Abstract

Background: 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.

Methods: 142 patients were retrospectively enrolled and stratified into straight stent 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.

Results: TS had a lower incidence of postprocedural 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 postprocedural 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 postprocedural HD (42.2% vs. 67.3%; P = 0.013). Logistic analyses found that eccentric stenosis (odds ratio [OR] = 2.561; 95% confidence interval [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 postprocedural HD. The following factors were identified as risk factors for persistent hemodynamic depression: 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 distance from the carotid bifurcation, the lower the risk of persistent hemodynamic depression (OR = 0.942; 95% CI = 0.894-0.992; P = 0.024).

Conclusions: TS reduces the risk of postoperative HD and there is 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.

Keywords: Hemodynamic depression; In-stent restenosis; Stenosis morphology; Tapered carotid stent.