Hang Yu, Wu Wen-Tao, Liu Xing-Long, Wang Bin, Zhou Chun, Shi Hai-Bin, Liu Sheng
Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Anesthesiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
Neurosurg Rev. 2025 Mar 27;48(1):331. doi: 10.1007/s10143-025-03466-5.
There are limited data on the impact of light sedation (LS) on changes in intraoperative hypotension related to carotid artery stenting (CAS). We aimed to investigate intraoperative hypotension and perioperative complications in CAS under LS with intravenous dexmedetomidine (Dex). A retrospective analysis of 140 consecutive patients who underwent CAS at our centre from September 2018 to March 2021 was performed. The primary endpoint was the incidence of intraoperative hypotension associated with CAS, defined as continuous systolic blood pressure < 90 mmHg. The secondary outcomes were perioperative complications, including dysphoria, transient ischaemic attacks (TIA), stroke, myocardial infarction (MI), reperfusion syndrome, and 24-h haemodynamic events after CAS. Eighty-nine patients were treated under LS, and 51 patients were treated under local anaesthesia (LA). Intraoperative haemodynamic instability was observed in 13 of 140 (9.3%) patients; hypotension occurred in 2.2% (2/89) of patients in the LS group, which was significantly lower than the rate in the LA group (2.2% vs. 11.8%, P = 0.027). Dysphoria occurred in 1.1% of the LS cohort and 15.7% of the LA cohort (P < 0.05). TIA was observed in 2.2% of the LS cohort and 15.7% of the LA cohort (P < 0.05), respectively. There were no statistically significant differences in periprocedural stroke, reperfusion syndrome, or 24-h haemodynamic events after CAS between the two groups, and none of the patients exhibited MI. Performing CAS under LS with intravenous Dex was a safe and effective anaesthesia option in terms of inhibiting intraoperative hypotension and could markedly decrease the incidence of dysphoria and TIA.
关于轻度镇静（LS）对与颈动脉支架置入术（CAS）相关的术中低血压变化的影响，目前数据有限。我们旨在研究在静脉注射右美托咪定（Dex）进行轻度镇静的情况下，CAS术中的低血压情况及围手术期并发症。对2018年9月至2021年3月在本中心连续接受CAS的140例患者进行了回顾性分析。主要终点是与CAS相关的术中低血压发生率，定义为持续收缩压<90 mmHg。次要结局是围手术期并发症，包括烦躁不安、短暂性脑缺血发作（TIA）、中风、心肌梗死（MI）、再灌注综合征以及CAS术后24小时的血流动力学事件。89例患者接受轻度镇静治疗，51例患者接受局部麻醉（LA）治疗。140例患者中有13例（9.3%）出现术中血流动力学不稳定；轻度镇静组患者中低血压发生率为2.2%（2/89），显著低于局部麻醉组（2.2%对11.8%，P = 0.027）。轻度镇静组中1.1%的患者出现烦躁不安，局部麻醉组中这一比例为15.7%（P < 0.05）。轻度镇静组和局部麻醉组中TIA的发生率分别为2.2%和15.7%（P < 0.05）。两组在CAS术后围手术期中风、再灌注综合征或24小时血流动力学事件方面无统计学显著差异，且无一例患者发生心肌梗死。在抑制术中低血压方面，静脉注射Dex进行轻度镇静下的CAS是一种安全有效的麻醉选择，并且可以显著降低烦躁不安和TIA的发生率。
