Carotid artery stenting (CAS) is one of major treatments in prevention of ischemic stroke. Because of sinus reflex due to stenting and balloon dilatation, persistent post-surgery hypotension is a common perioperative event. Persistent hypotension can lead to perioperative adverse events like ischemic stroke, myocardial infraction, renal failure and death; or more usually, it prolongs length of stay and hospital expenses. Renin-angiotensin-aldosterone inhibitor (RASI) could inhibit the release of catecholamine and may lead to higher rate of persistent hypotension after CAS compared to other hypertensives.Thus, the investigators aim to investigate the effect of pre-operation antihypertensive drugs on persistent hypotension after stenting, and followed burden in carotid artery stenting comorbid with hypertension patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
560
Pre-operative antihypertensive drugs before stenting will be random assigned (RASI or CCB) at least 5 days before stenting. Patients in RASI group will receive RASI (all kinds of RASI will be permited and the trade name or universal name of drugs will not be limited), with or without other antihypertensives except for CCB (any kind of CCB). Blood pressure of patients should be controlled within the target range (140/90 mmHg); and usage and dosage of antihypertensive drugs will not be stipulated. Grapefruit intaking should be avoid.
Pre-operative antihypertensive drugs before stenting will be random assigned (RASI or CCB) at least 5 days before stenting. Patients in CCB group will receive CCB (all kinds of CCB will be permited and the trade name or universal name of drugs will not be limited), with or without other antihypertensives except for RASI (any kind of RASI). Blood pressure of patients should be controlled within the target range (140/90 mmHg); and usage and dosage of antihypertensive drugs will not be stipulated. Grapefruit intaking should be avoid.
West China Hospital, Sichuan University
Chengdu, Sichuan, China
The incidence of persistent post-surgery hypotension
systolic blood pressure (SBP) \< 90 mmHg or requiring vasopressor with lasting \> 6 hours, and without evidence hypovolemia and heart failure
Time frame: the first 24 hours after CAS
Length of stay after surgery
Time frame: From surgery to dicharge, up to 3 month.
Hospital expenses after surgery, based on payment list in hospital information system
Payment list in hospital information system for all patients will be recorded with permission and the hospital expenses after surgery will be caculated based on those records.
Time frame: From surgery to dicharge, up to 3 month.
Difference of serum catecholamine (adrenalin, norepinephrine and dopamine) before and after surgery (all in unit of nmol/L)
Time frame: at morning (7 o'clock am) of the day of surgery and the first day after surgery
Difference of heart rate variability (HRV) before and after surgery
Time frame: 24 hours before surgery to at least 24 hours after surgery
The incidence of bradycardia after surgery
Time frame: the first 24 hours after CAS
The total incidence of stroke, myocardial infraction, renal failure and embolism of retinal arteries
Time frame: From surgery to dicharge, up to 3 month.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.