Invasive Hemodynamic Monitoring During Carotid Intervention - Is It Necessary?
Brendan Jones, MD, Samantha D. Minc, MD, MPH, Dylan Thibault, MS, Lakshmikumar Pillai, MD.
West Virginia University, Morgantown, WV, USA.
Objective: Carotid artery stenosis presents a significant risk for stroke/TIA. Carotid artery stenting (CAS) is widely used in high-risk patients. Guidelines regarding peri-procedural management for CAS cite the need for invasive arterial pressure monitoring (IAM). However, arterial catheter insertion is time-consuming, painful for the patient, and can lead to hemorrhagic, thrombotic, or infectious complications. The use of non-invasive monitoring (NIAM) has been evaluated as a suitable alternative in select CEA cases. This has not been studied in CAS. The purpose of this study was to identify whether patients undergoing transfemoral-CAS with IAM at our institution have different outcomes than patients who had NIAM. Methods: A prospectively maintained institutional dataset from 2017-2022 was used for analyses. Patient characteristics and peri-operative outcomes were assessed univariately using chi-square and Wilcoxon tests for categorical and continuous variables. Fisher's exact tests were used where appropriate. Multivariable logistic regression was used to ascertain the association of IAM on a composite endpoint consisting of operative mortality, post-operative MI, or new neurological event. Adjustment variables were selected based on clinical knowledge and from univariate analyses. Generalized estimating equations were used to account for variation across surgeons using an independent working correlation. Results: 229 patients underwent CAS during the study period, of which 89 had IAM. 14 patients overall sustained the composite endpoint. Patients with IAM had lower median BMIs, were less likely to have a prior CABG/PCI or prior CEA/CAS and were less likely to undergo elective CAS; they also had longer median procedure times, higher rates of prior stroke/TIA, and were more likely to have symptomatic stenosis. Univariate analyses revealed no significant difference in post-operative outcomes by invasive monitoring status (Table #1). After adjusting for patient factors we found no difference in the odds of the composite endpoint between groups (AOR:0.67;95% CI:0.27-1.68, p=0.3887).Conclusions: This study found no difference in operative mortality, post-operative MI, or new neurological event in patients receiving IAM during CAS compared to those receiving NIAM. These results support the use of NIAM in CAS patients and has implications for cost/time savings, and patient risk. Additional research with larger samples sizes is merited.
|Outcome||Overall (N = 229)||Non-invasive arterial monitoring (N = 140)||Invasive arterial monitoring (N = 89)||P-value|
|Operative mortality||3 (1.31%)||3 (2.14%)||0 (0.0%)||0.2841|
|Post-op MI||4 (1.75%)||3 (2.14%)||1 (1.12%)||1.0000|
|Stroke/TIA||8 (3.51%)||4 (2.88%)||4 (4.49%)||0.7146|
|Stroke/TIA same side as lesion||7 (3.07%)||3 (2.16%)||4 (4.49%)||0.4360|
|Composite endpoint (Mortality, post-op MI, stroke/TIA)||14 (6.11%)||9 (6.43%)||5 (5.62%)||1.0000|
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