BACKGROUND: Hemodynamic instability (HI), manifesting as hypotension and/or bradycardia, presents a common complication within 6 h post-CAS. The prolonged HI requires particular attention due to increased risk of neurologic complications. AIMS: The study aimed to determine the incidence and potential predictive factors of prolonged hemodynamic instability (HI) after carotid artery stenting (CAS). METHODS: From January 2023 to January 2025, patients diagnosed with carotid artery stenosis underwent CAS treatment were recruited. The data of peri-procedural characteristics extracted from the Hospital electronic database. Prolonged HI was defined as post-procedural HI persisting beyond 24 h, with or without associated symptoms. Logistic regression identified predictors of HI. A nomogram was developed based on the regression analysis. The receiver operating characteristic (ROC), Hosmer-Leme and decision curve analyses were used to assess predictive performance. RESULTS: The training cohort consisted of 234 cases, while the validation cohort included 100 cases. The logistic regression identified intraoperative HI (OR = 2.77, p = 0.02), Large balloon (OR = 10.53, p 5% to < 95%. The nomogram's performance metrics were: AUC = 0.92, accuracy = 0.89, specificity = 0.94, sensitivity = 0.94, PLR = 5.8, NLR = 0.07, and DOR = 82.25. CONCLUSION: This study confirms that intraprocedural HI, Large balloon, large-diameter stent use (7-10 mm), and post-balloon dilatation were independent risk factors for prolonged HI following CAS. The integration of these factors into a nomogram provides clinicians with a highly accurate tool for preoperative risk stratification.
Liu et al. (Sun,) studied this question.