Cardiac Arrest Induced by Carotid Sinus Reflex Activation During Flow-Diverter Stent Deployment

Goto, Shunsaku; Izumi, Tohru; Nishihori, Masahiro; Ishida, Mamoru; Ishida, Tetsuya; Otawa, Masato; Kawaguchi, Tomoki; Oshima, Ryosuke; Kropp, Asuka Elisabeth; Ikezawa, Mizuka; Wakabayashi, Toshihiko

doi:10.1016/j.wneu.2018.12.136

Cited by 4 publications

(8 citation statements)

References 8 publications

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“…When CSR is suspected, slightly pulling down the delivery catheter until the tension in the carotid sinus decreases has been recommended as the first step in the management of CSR. 5) In our case series, the normal hemodynamics were immediately restored in all cases of severe CSR. The prophylactic use of atropine has been reported to be effective in preventing the triggering of the CSR during CAS.…”

Section: Discussionsupporting

confidence: 48%

“…[7][8][9] However, there is no report of CSR as a complication of PED deployment other than our previous case report. 5) Therefore, this is the first study investigating the relationship between triggering of the CSR and PED deployment. Triggering of the CSR commonly occurs during carotid artery stenting (CAS).…”

Section: Discussionmentioning

confidence: 99%

“…3,4) We previously reported a case complicated by cardiac arrest during PED deployment induced by triggering of the carotid sinus reflex (CSR). 5) We have observed bradycardia and hypotension during PED deployment under local anesthesia with mild sedation and consider that the carotid sinus is stimulated by pushing the delivery catheter further in to achieve adequate PED expansion to the vessel wall.…”

Section: Introductionmentioning

confidence: 99%

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Triggering of Carotid Sinus Reflex during Deployment of the Flow-diverter Device

Goto

Izumi

Nishihori

et al. 2021

Neurol. Med. Chir.(Tokyo)

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The carotid sinus reflex (CSR) is a rare complication of the Pipeline Embolization Device (PED) deployment. No study has assessed the potential risk factors in a case series. The purpose of this study was to examine CSR triggering during PED deployment. Thirty-seven consecutive patients who underwent PED deployment were included. All procedures were performed under local anesthesia with mild sedation. We retrospectively analyzed patient characteristics, PED deployment time, and vital signs during the procedure. The vital signs included the pulse rate (PR) and systolic blood pressure (SBP) obtained at three timepoints (pre-deployment, during deployment, post-deployment). We examined the triggering of the CSR during PED deployment by comparing the vital signs at the three timepoints. Moreover, risk factors for CSR were analyzed with univariate analysis. The patients' average age was 66.3 years. The average size of the aneurysm was 18.0 mm. Six patients (16.2%) showed a decline in the SBP or PR defined as CSR. One patient had a transient cardiac arrest and two had severe transient bradycardia. Deployment into the ophthalmic segment of the internal carotid artery (C2 segment) aneurysm (p = 0.022), prolonged PED deployment time more than 14.5 minutes (p = 0.005), and an acute angle of the anterior genu less than 51.5 degrees (p = 0.005) were risk factors in triggering CSR. CSR may be triggered during PED deployment under local anesthesia with mild sedation. Deployment to the C2 segment aneurysm, prolonged PED deployment time, and an acute angle of the anterior genu were associated with CSR triggering.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Triggering of Carotid Sinus Reflex during Deployment of the Flow-diverter Device

Goto

Izumi

Nishihori

et al. 2021

Neurol. Med. Chir.(Tokyo)

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“…The sinus arrest was probably a temporary phenomenon, since cardiac arrhythmia caused by the compression of the carotid sinus receptor usually returns to normal after the causative factors, such as a percutaneous transluminal balloon and the delivery wire of the flow-diverter, have been eliminated. 5) In the present case, the 3DRA performed to visualize the contralateral internal carotid artery did not cause a carotid sinus reflex. This finding suggests a definite laterality in baroreflex sensitivity.…”

Section: Discussionsupporting

confidence: 45%

“… 1 – 4) A recent report showed that cardiac arrest can also be elicited during the deployment of a flow-diverter. 5) To the best of our knowledge, however, no previous reports have described severe hemodynamic instability related to diagnostic rotational angiography (RA).…”

Section: Introductionmentioning

confidence: 99%

Sinus Arrest and Bradycardia Induced by Carotid Baroreceptor Reflex Activation during Rotational Angiography: A Case Report

Kojima

Saga

Kanki

et al. 2021

JNET

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We describe a rare patient with a cavernous sinus dural arteriovenous fistula (CS DAVF) in whom diagnostic rotational angiography (RA) caused sinus arrest and bradycardia.Case Presentation: A 79-year-old woman with no previous history of cardiovascular diseases presented with left oculomotor nerve paresis. Conventional angiography confirmed a bilateral CS DAVF. During a three-dimensional RA (3DRA) examination of the left internal carotid artery, sinus arrest occurred. Subsequently, the use of 3DRA to image the left external carotid artery and the use of cone beam computed tomography (CBCT) to image the left internal and external carotid artery also caused transient sinus bradycardia. Two weeks later, we inserted a temporary transvenous pacemaker and completed the transvenous embolization of the left CS DAVF. The left oculomotor paresis improved without any perioperative complications. Conclusion:RA is a standard radiological modality for the diagnosis of cerebrovascular disease. Although the physical force generated by the injection of the contrast medium at the carotid bifurcation can theoretically cause hemodynamic instability, no previous reports have described sinus arrest or bradycardia in association with diagnostic carotid angiography. The present case demonstrates that 3DRA and CBCT can provoke rare, but serious, incidences of cardiac arrhythmia.Keywords▶ carotid baroreceptor reflex, cone beam computed tomography, dural arteriovenous fistula, sinus arrhythmia, three-dimensional rotational angiography bifurcation. [1][2][3][4] A recent report showed that cardiac arrest can also be elicited during the deployment of a flow-diverter. 5) To the best of our knowledge, however, no previous reports have described severe hemodynamic instability related to diagnostic rotational angiography (RA).Here, we report a patient with a cavernous sinus dural arteriovenous fistula (CS DAVF) who experienced a sinus arrhythmia during three-dimensional RA (3DRA) and cone beam computed tomography (CBCT) for the visualization of the internal and external carotid arteries. Case PresentationA 79-year-old woman had noted diplopia and left ocular pain for 2 months prior to visiting our institute. She had no past cardiac history. Her physical examination revealed ptosis, a mildly dilated pupil, an impaired downward gaze, and an impaired rightward gaze in the left eye, suggesting left oculomotor nerve paresis. Magnetic resonance imaging and This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Cardiac Arrest Induced by Carotid Sinus Reflex Activation During Flow-Diverter Stent Deployment

Cited by 4 publications

References 8 publications

Triggering of Carotid Sinus Reflex during Deployment of the Flow-diverter Device

Triggering of Carotid Sinus Reflex during Deployment of the Flow-diverter Device

Sinus Arrest and Bradycardia Induced by Carotid Baroreceptor Reflex Activation during Rotational Angiography: A Case Report

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