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Barostim Implantation with Ipsilateral Carotid Endarterectomy as a One-Stage Procedure
Kay F Weipert1, Astrid Most1, Oliver Doerr1
1Division of Cardiology, Department of Internal Medicine I, Justus-Liebig University of Giessen, Giessen, Germany.
Insights
Baroreflex activation therapy (BAT) safely lowered blood pressure in a patient with carotid atherosclerosis after surgery. This approach offers a new option for resistant hypertension management in complex cases.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Medical Device Technology
Background:
- Resistant hypertension management often involves invasive therapies.
- Baroreflex activation therapy (BAT) uses carotid sinus stimulation for blood pressure reduction.
- Carotid atherosclerosis has been a contraindication for BAT due to stroke risk.
Observation:
- A patient with significant cerebral arteriosclerosis post-carotid endarterectomy was considered for BAT.
- The procedure was performed as a one-stage implantation without neurologic complications.
Findings:
- BAT was successfully and safely applied in this complex patient.
- Satisfactory blood pressure reduction was maintained over an 18-month follow-up period.
- The therapy proved effective despite the presence of cerebral arteriosclerosis.
Implications:
- BAT may be a viable treatment option for resistant hypertension in patients with carotid atherosclerosis.
- This case expands the potential patient population for baroreflex activation therapy.
- Further research is warranted to confirm safety and efficacy in similar complex cases.
Abstract:
Clinical trials have demonstrated significant and lasting reductions in arterial pressure from baroreflex activation therapy (BAT), resulting from electrical stimulation of the carotid sinus in patients with resistant arterial hypertension. Significant carotid atherosclerosis, however, has been a contraindication for ipsilateral implantation due to a potentially increased risk of periprocedural stroke and uncertain antihypertensive efficacy. Here, we describe the first case in which BAT was applied safely and effectively in a patient with distinct cerebral arteriosclerosis after ipsilateral carotid endarterectomy as a one-stage procedure without neurologic complications. BAT resulted in satisfactory blood pressure levels despite distinct cerebral atherosclerosis after an 18-month follow-up period.
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