Risk factors for hemodynamic depression after carotid artery stenting:a system review and meta analysis

J Stroke Cerebrovasc Dis. 2025 May 6:108340. doi: 10.1016/j.jstrokecerebrovasdis.2025.108340. Online ahead of print.

ABSTRACT

PURPOSE: Hemodynamic depression (HD) regularly occurs during carotid artery stenting(CAS) for treating carotid stenosis and it could result in adverse clinical events. This review aimed to clarify the incidence and risk factors for HD.

METHODS: We searched four comprehensive databases for studies that reported the incidence or risk factors for HD during CAS. We used a modified version of Newcastle-Ottawa scale to assess the risk of bias in the included studies. We pooled the prevalence rates of HD and related risk factors from individual studies with a generic inverse variance weighted using the randomized effects model. We reported the results using OR with 95% CI. Funnel plots and Egger’s tests were used to assess the publication bias.

RESULTS: Our meta-analysis enrolled 53 articles and revealed that the incidence of HD was 35%. Patients who had diabetes (OR=1.28, 95% CI: 1.07 to 1.54), stenosis-to-bifurcation <10 mm (OR=2.11, 95% CI: 1.29 to 3.48), stenosis involving the carotid bulb (OR=1.9, 95% CI: 1.07 to 3.38), calcified plaque (OR= 2.06, 95% CI: 1.32 to 3.22), eccentric plaque (OR=1.47, 95% CI: 1.05 to 2.05), severe stenosis (OR=1.64, 95% CI: 1.1 to 2.43), contralateral stenosis (OR=2.02, 95% CI: 1.18 to 3.46), open-cell stents (OR= 1.5, 95% CI: 1.04 to 2.15), and bilateral stenting (OR=2.32, 95% CI: 1.56 to 3.44) showed a higher risk of HD.

CONCLUSIONS: Diabetes, stenosis-to-bifurcation <10 mm, stenosis involving the carotid bulb, calcified plaque, eccentric plaque, severe stenosis, contralateral stenosis, open-cell stents, and bilateral carotid stenting were associated with HD during CAS.

PMID:40339731 | DOI:10.1016/j.jstrokecerebrovasdis.2025.108340