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Bradycardia and Asystole in Patients Undergoing Symptomatic Chronically Occluded Internal Carotid Artery

Joseph S Hudson1, Mario Zanaty1, Victoria Wadman2

  • 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

World Neurosurgery
|July 27, 2019
PubMed

Insights

Endovascular recanalization of chronically occluded internal carotid arteries (COICA) frequently causes bradycardia. Careful monitoring during COICA revascularization is essential due to potential symptomatic events and the carotid sinus baroreceptors

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Vascular Surgery

Background:

  • Successful endovascular recanalization of chronically occluded internal carotid arteries (COICA) has been reported.
  • The effect of restoring flow on carotid sinus baroreceptors is not well understood.
  • This study presents the largest surgical series of COICA, focusing on perioperative heart rate changes.

Purpose of the Study:

  • To investigate the incidence and characteristics of perioperative heart rate abnormalities during COICA revascularization.
  • To assess the impact of endovascular procedures on carotid sinus baroreceptor activity.
  • To highlight the necessity of close patient monitoring during COICA treatment.

Main Methods:

  • Retrospective analysis of 37 COICA revascularization procedures in 36 patients.
  • Radiographic classification of COICA based on stenosis distribution and collateral flow.
  • Collection and analysis of patient demographics and perioperative heart rate data.

Main Results:

  • Intraprocedural bradycardia occurred in 23 patients (62%) during balloon angioplasty.
  • Three patients experienced transient asystole; two had symptomatic bradycardia with cerebral changes, one requiring a permanent pacemaker.
  • Bradycardia resolution was immediate upon balloon deflation and pharmaceutical management.
  • A significant association was found between bradycardia and COICA classifications (P = 0.014).

Conclusions:

  • Bradycardia is common during COICA revascularization, affecting the majority of patients.
  • A small subset of patients experienced symptomatic bradycardia requiring intervention.
  • Carotid sinus baroreceptors appear to remain active even in complete arterial occlusion, necessitating vigilant monitoring during proximal COICA angioplasty.
Abstract

Keywords:
AngiographyArrhythmiasAutonomic nervous systemCerebrovascular proceduresHemodynamicsPhysiologyStenosis

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