Carotid sinus syndrome in carotid angioplasty with stenting

Abstract

Introduction. Significant progress has been made in primary stroke prevention, including through the widespread use of carotid angioplasty with stenting (CAS). At the same time, there is a growing number of publications reporting the development of carotid sinus syndrome (CSS) (haemodynamic instability) in the periope- rative period, as well as cerebral and cardiac complications and death, which requires in-depth study to improve the quality of medical care for patients with carotid artery stenosis.

The aim of the study was to determine the frequency, risk factors, clinical features and outcomes of CSS in patients with carotid artery stenosis undergoing CAS.

Materials and methods. The study included 120 patients with carotid artery disease, who underwent an elective surgical intervention consisting of transluminal balloon angioplasty. All patients underwent comprehensive clinical and laboratory tests and imaging studies.

Results. CSS developed in 70% of cases (n = 84) of carotid artery stenosis, and was significantly more common in men than women (71.4% vs. 28.6%, respectively) (p < 0.05). The median age of all patients with CSS was 68 (44–91) years. Mixed form of CSS was significantly more common than the cardioinhibitory or vasodepressor forms (p < 0.05). In more than half of all cases, symptoms developed during balloon dilatation or within an hour afterwards. The duration of CSS was 30–40 hours. Contralateral carotid occlusion was detected in 12 (10%) patients, significantly (p < 0.05) more often in patients with CSS (13%) compared to patients without CSS (2.8%).

Conclusion. Regardless of stenosis severity or symptoms, CAS is accompanied by CSS in 2/3 of cases. The CSS is predominantly a mixed type and can be accompanied by loss of consciousness in rare cases. CSS appears both intraoperatively and in the early postoperative period, and its average duration is 1.5 days. A factor that may be associated with CSS development is contralateral carotid artery occlusion (p > 0.05).

About the authors

Roman V. Polishchuk

Research Center of Neurology

Author for correspondence.
Email: romapol@mail.ru
ORCID iD: 0000-0003-2850-3999

anesthesiologist-reanimatologist, neurologist, Intensive critical care department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Мikhail A. Piradov

Research Center of Neurology

Email: romapol@mail.ru
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med), Prof., Full Member of RAS, Director, Research Center of Neurology, Moscow, Russia; Head, Division of diseases of the nervous system

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Yulia V. Ryabinkina

Research Center of Neurology

Email: romapol@mail.ru
ORCID iD: 0000-0001-8576-9983

D. Sci. (Med.), Head, Intensive critical care department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Vladimir L. Shchipakin

Research Center of Neurology

Email: romapol@mail.ru
ORCID iD: 0000-0003-1428-2769

Cand. Sci. (Med.), Head, Group of vascular and endovascular surgery, senior researcher

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Aleksandr Yu. Koshcheev

Research Center of Neurology

Email: romapol@mail.ru
ORCID iD: 0000-0003-0160-7499

Cand. Sci. (Med.), cardiovascular surgeon, Group of vascular and endovascular surgery

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Polina R. Prokazova

Research Center of Neurology

Email: romapol@mail.ru
ORCID iD: 0000-0001-5837-6391

Cand. Sci. (Med.), neurologist, Intensive critical care department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

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Copyright (c) 2021 Polishchuk R.V., Piradov М.A., Ryabinkina Y.V., Shchipakin V.L., Koshcheev A.Y., Prokazova P.R.

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