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Adventitial stripping for carotid sinus syndrome
R J Toorop1, M R M Scheltinga, F L Moll
1Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. rtoorop@yahoo.com
Insights
Carotid sinus syndrome (CSS) causes dizziness and fainting due to baroreflex issues. Surgical carotid denervation, or adventitial stripping, effectively treats all CSS types with a high success rate and low complications.
Area of Science:
- Neurology
- Cardiology
- Vascular Surgery
Background:
- Carotid sinus syndrome (CSS) involves exaggerated carotid baroreflex responses, leading to syncope and dizziness.
- Existing treatments like pacemakers are primarily effective for the cardioinhibitory type of CSS.
- A need exists for treatments addressing all CSS subtypes.
Purpose of the Study:
- To review the efficacy and safety of surgical adventitial stripping of the carotid sinus for treating CSS.
- To evaluate this surgical approach across different types of carotid sinus syndrome.
Main Methods:
- Analysis of data from 130 surgical procedures involving adventitial stripping of the carotid sinus.
- Review of patient outcomes, including symptom relief and complication rates.
Main Results:
- Adventitial stripping demonstrated effectiveness in 85% of patients with CSS.
- The surgical technique showed low complication rates.
- Transient blood pressure and heart rate alterations were noted postoperatively, necessitating monitoring.
Conclusions:
- Surgical carotid denervation via adventitial stripping is a highly effective treatment for all forms of carotid sinus syndrome.
- This surgical intervention offers a viable alternative to pacemakers, particularly for vasodepressor and mixed CSS types.
- Close postoperative monitoring is essential to manage potential transient hemodynamic changes.
Abstract:
Patients with a carotid sinus syndrome (CSS) suffer from spells of dizziness and loss of conscience due to an exaggerated carotid baroreflex response. Three types of the syndrome are described: cardioinhibitory, vasodepressor and a mixed form. The gold standard for treatment is insertion of a pacemaker, but this therapy may be effective only in a pure cardioinhibitory type. In contrast, surgically interrupting afferent nerves at the origin may offer relief of symptoms in all three types. The present review analyzes the results of a surgical technique termed "adventitial stripping" of the carotid sinus. Data from 130 procedures demonstrate that carotid denervation is effective in 85% of CSS cases with low complication rates. Postoperative monitoring is mandatory as transient alterations in blood pressure and heart rate may occur.