Carotid sinus reactions during carotid artery stenting: Predictors, incidence, and influence on clinical outcome

Abstract

Carotid sinus reactions (CSR), defined as asystole >/= 3 sec and hypotension (systolic blood pressure </= 90 mm Hg), are frequent events during carotid artery stenting (CAS). Factors predisposing a patient to CSR as well as the impact of CSR on periprocedural complications have not yet been investigated in a prospective manner. The relationship between various clinical, morphologic, and procedural variables and the occurrence of CSR was examined among 105 consecutive patients undergoing successful CAS. After predilatation with a compliant balloon, tubular-slotted stents were used in all patients. No CSR occurred in 63 (60%) patients, whereas CSR developed in 42 (40%) patients. The most common type of CSR was asystole in combination with short-term hypotension without clinical symptoms. The most important predictor of CSR was bifurcation location of carotid stenosis (bifurcation > ostial > isolated internal carotid artery; P < 0.001). The other independent predictors were presence of contralateral stenosis (P < 0.02), length of stenosis (P < 0.03), and balloon-to-artery ratio (P < 0.02). Occurrence of CSR was unrelated to periprocedural cerebral or cardiovascular complications (7.1% vs. 9.5%; NS). We conclude that CSR occurs frequently (40%) during CAS. Bifurcation location of stenosis is the most important predictor of CSR. CSR does not increase the risk of periprocedural complications.

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

“…Finally, the total incidence of HD in our series was not higher than that in reported studies. 18,22,[35][36][37] All of the patients with HD in our study recovered spontaneously or after infusion of normal saline and/or volume expanders or occasionally with the use of vasopressors and/or anticholinergics. HD during CAS is relatively common and benign, without an increase of perioperative risks.…”

Prolonged Carotid Sinus Reflex Is a Risk Factor for Contrast-Induced Nephropathy following Carotid Artery Stenting

“…34 With detailed multimodal preoperative assessment and careful determination of angioplasty balloon size, the incidence of prolonged hypotension could be suppressed 10% (8/80) in our study, compared with other studies. 12,13,15,35,36 Once prolonged CSR occurred, continuous intravenous vasopressor infusion was immediately administered with monitoring of vital signs, urine output, and neurologic signs and symptoms. Despite the prevention of excessive hypotension and the maintenance of sufficient urine output, prolonged CSR was an independent risk factor for CIN.…”

“…The frequency of development of prolonged CSR following CAS procedures varies from 11% to 42%, and plaque characteristics and anatomic risk factors associated with such hemodynamic depression include calcified plaque, fibrous plaque, eccentric plaque, lesions involving the carotid bulb, presence of contralateral stenosis or occlusion, length of stenosis, right-sided lesions, and balloon-to-artery ratio. [12][13][14][15][16] The clinical efficacy of CEA was established in clinical trials for symptomatic and asymptomatic carotid occlusive disease. 17,18 CAS has been recommended as a less invasive but potentially equally effective treatment for carotid disease.…”

Hemodynamic instability following carotid artery stenting

“…A history of MI was found to be a predictive factor for postprocedural hypotension and bradycardia. Leisch et al 9 reported on the proximity of stenosis to the carotid bifurcation as the most important predictor of HI. Other predictors were identified as existence of contralateral stenosis (> 60%), length of the stenosis, and balloonto-artery ratio.…”