Carotid angioplasty and stent-induced bradycardia and hypotension: Impact of prophylactic atropine administration and prior carotid endarterectomy

Abstract

The administration of prophylactic atropine before balloon inflation during CAS decreases the incidence of intraoperative bradycardia and cardiac morbidity in primary CAS patients. Periprocedural bradycardia, hypotension, and the need for vasopressors occur more frequently with primary CAS than with redo CAS procedures. On the basis of our data, we recommend that prophylactic atropine administration be considered in patients with primary carotid lesions undergoing CAS.

Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience

“…36 These events are usually treated with atropine even in a prophylactic mode. 37 We do not support the indiscriminate use of atropine, to avoid its adverse effects (tachycardia, gastrointestinal disturbances, bronchoconstriction, blurred vision, dizziness, and photophobia). In an empirical way, we controlled the arterial pressure and cardiac rate during the procedure and treated with urapidil and beta blockers only when it was necessary.…”

Predictors and Timing of Hypotension and Bradycardia after Carotid Artery Stenting

“…[1][2][3]12,13,[15][16][17][18] To date, the risk factors that have been found to be independently associated with a higher risk of hypotension and bradycardia during or after CAS are as follows: older age, 14,18 female, 18 previous MI, 13,18 history of CAD, 14 intraprocedural hypotension or bradycardia, 13 stenosis localization (on the carotid bulb or within 10 mm of the carotid bulb), 2,3,16 stenosis length, 3 presence of calcification, 2,16 fibrous plaque, 16 eccentric plaque, 16 high balloon-toartery diameter ratio, 3 and presence of a contralateral stenosis, 3 ; whereas a history of a previous CEA was found to be associated with a lower risk. 2 In the present study, because the baseline values of systolic BP and PR are variable from one patient to another, we preferred to use their relative percentage change rather than their absolute value.…”

“…So far, the reported predictors vary from one study to another. [1][2][3][12][13][14][15][16][17][18] The study end points, as well as the time point and the duration of the vital sign (VS) monitoring, are also highly variable. Absolute blood pressure (BP) and pulse rate (PR) values 2,3,13,14,[16][17][18] or absolute decrease in their initial values 1,3,16 are used in most reports, and a standardized follow-up time for VS monitoring is rarely defined.…”

Spasmolytic effect of citral and extracts of Cymbopogon citratus on isolated rabbit ileum

“…Citral appeared to induce relaxation through NO pathway and blockade of calcium channels via VOCC and/or receptor-operated calcium channel (Cayne et al, 2005). Furthermore, citral may also act by directly blocking the muscarinic receptor and possibly by inhibiting the production and/or action of the second messenger, IP3 causing the visceral smooth muscle to relax.…”