Study on the correlation between preoperative blood pressure variability and postoperative carotid sinus reaction in carotid artery stenting

ObjectiveTo investigate the relationship between preoperative 24 h ambulatory blood pressure variability (BPV) and postoperative carotid sinus reaction (CSR) in carotid artery stenting, and to find BPV indicators that can predict CSR.

MethodsA total of 59 patients with carotid artery stenosis undergoing carotid artery stenting were selected and divided into CSR group and non-CSR group according to the definition of CSR.The patients in the CSR group were further divided into three subtypes: hypotension type, bradycardia type, and mixed type.The preoperative 24 h blood pressure changes were monitored with a non-invasive portable blood pressure monitor, and the 24 h, daytime and nighttime mean systolic blood pressure (MSBP), diastolic blood pressure (MDBP) of patients were compared, as well as their standard deviation (SD) and coefficient of variation (CV).

ResultsAmong the 59 patients, 25 cases did not have CSR, and 34 cases had CSR, among which, 19 cases were hypotension type, 8 cases were bradycardia type, and 7 cases were mixed type.The hypertension, smoking history, and degree of vascular stenosis in the CSR group were higher than those in the non-CSR group (P<0.05), and hypertension was an independent risk factor for CSR (P<0.01).The 24 h MDBP, DBP-SD/CV, and SBP-SD/CV of CSR patients were higher than those of non-CSR patients (P<0.01).At the same time, there were statistically significant differences in daytime and nighttime SBP-SD/CV and DBP-SD/CV of patients between the two groups (P<0.01).Further analysis showed that the SD and CV of 24 h SBP and DBP were positively correlated with the occurrence of postoperative CSR in patients (P<0.01).Univariate analysis of variance showed that the CV of 24 h DBP in mixed type CSR patients was higher than that in hypotensive and bradycardia patients (P<0.05), the daytime and nighttime SD and CV of SBP in mixed type patients were higher than those in hypotensive and bradycardia patients (P<0.05), and the nighttime SD and CV of DBP in mixed type patients were also higher than those in hypotensive patients (P<0.05).Multiple logistic regression showed that 24 h CV of DBP and the SD/CV of SBP in day and night were independent risk factors for mixed type (P<0.05).

ConclusionsPreoperative BPV is associated with the occurrence and type of CSR in carotid artery stenting, indicating that BPV can be used as a predictor of specific types of CSR in patients after surgery.