Abstract
BackgroundHypotension and bradycardia are common hemodynamic complications following carotid artery stenting in patients with carotid artery stenosis. Intravenous fluid resuscitation and inotropes such as dopamine are conventional treatments for post-carotid artery stenting hypotension. However, in case of resistant hypotension, there is no clear treatment method. In this report, while intravenous fluid and inotropes did not resolve the patient’s hypotension, oral midodrine treated post-carotid artery stenting hypotension.Case presentationIn this report, we present an 82-year-old Caucasian man complaining of a single episode of unilateral visual loss. The patient had left internal carotid artery stenosis and underwent carotid artery stenting. After the procedure, he developed prolonged post-carotid artery stenting hypotension, which was resistant to intravenous fluids and inotropes but immediately showed a promising response to oral midodrine.ConclusionOral midodrine can be considered in treatment of post-carotid artery stenting hemodynamic complications.
Highlights
Hypotension and bradycardia are common hemodynamic complications following carotid artery stenting in patients with carotid artery stenosis
Oral midodrine can be considered in treatment of post-carotid artery stenting hemodynamic complications
In case of carotid artery stenting (CAS)-related hypotension, intravenous fluid resuscitation and vasopressors are usual treatments, but some studies have shown the effectiveness of oral midodrine, an alpha-adrenergic agonist, in treating these hemodynamic complications [13, 14]
Summary
Hypotension and bradycardia are common hemodynamic complications following carotid artery stenting in patients with carotid artery stenosis. Conclusion: Oral midodrine can be considered in treatment of post-carotid artery stenting hemodynamic complications. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are two major treatments for carotid stenosis, reducing the risk of stroke in these patients [3]. CEA is usually the treatment of choice but in certain conditions such as previous neck surgery, unfavorable carotid anatomy, history of neck radiation, and high-risk patients for surgery, CAS is preferred [4].
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