Impact of carotid stenting on blood pressure in patients with ipsilateral stenosis: clinical and hemodynamic predictors and their prognostic value

Aim. To determine clinical, anatomical, and intraoperative predictors of sustained blood pressure (BP) reduction in patients with ipsilateral internal carotid artery stenosis after carotid artery stenting (CAS).

Material and methods. This single-center prospective study included 178 patients who underwent CAS between 2018 and 2022. All patients underwent clinical BP measurements and ambulatory 24-hour BP monitoring (ABPM) before the [procedure and after 12 months. A sustained hypotensive response was defined as a reduction in average 24-hour systolic/diastolic BP ≥10/5 mm Hg, as measured by ABPM. Anatomical (stenosis degree, plaque morphology, circle of Willis structure, etc.), anthropometric and clinical parameters (age, sex, comorbidities, etc.), as well as intraoperative factors (hypotension, bradycardia, dilation, etc.) were studied.

Results. At baseline, hypertension was detected in 98,6% of patients, while target BP values were achieved in only 28,4%. A significant decrease in office BP was observed as early as 24 hours after CAS (systolic BP 157®114 mm Hg, diastolic BP 87®64 mm Hg; p<0,001). According to ABPM data, after 1-year follow-up, an average decrease in 24-hour BP of 12/9 mm Hg was recorded (p<0,001). A persistent BP reduction ≥10/5 mm Hg was observed in 46,6% of patients. In a multivariate analysis, independent predictors of persistent BP reduction were a incomplete circle of Willis (odds ratio (OR) 3,71; p=0,007), a stenosis >80% (OR 1,06; p=0,033), and intraoperative hypotension (OR 2,42; p=0,022). The number of antihypertensive medications taken by patients did not change statistically, but in 12 cases, the possibility of dosage reduction was noted. The circadian BP profile improved after the procedure (an increase in the proportion of "dipper" patients).

Conclusion. A persistent BP reduction after CAS was observed in almost half of patients with ipsilateral internal carotid artery stenosis. The severity of the hypotensive response is determined by cerebral circulation anatomy (disconnected structure of the circle of Willis), stenosis degree, and intraoperative reactions of the carotid sinus. These factors can be used to predict the hemodynamic response and optimize patient management after CAS.

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