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

Publication ,  Journal Article
Hudson, JS; Zanaty, M; Wadman, V; Nakagawa, D; Ishii, D; Roa, JA; Al Kasabz, S; Limaye, K; Rossen, JD; Jabbour, P; Adams, HP; Samaniego, EA; Hasan, DM
Published in: World Neurosurg
November 2019

BACKGROUND: Reports have emerged describing the successful endovascular recanalization of the chronically occluded internal carotid artery (COICA). The impact this restoration of flow has on the sensitive carotid sinus baroreceptors has not been previously described. In this manuscript, we present the largest COICA surgical series to date, with a specific focus on perioperative heart rate abnormalities. METHODS: Patient demographics were obtained, and the COICAs were radiographically classified based on the anatomic distribution of the stenosis and collateral flow. Thirty-six patients had a total of 37 COICA revascularization procedures. RESULTS: A total of 23 patients had intraprocedural bradycardia during balloon angioplasty. Three patients went into transient asystole during the procedure, and 2 of these patients had symptomatic bradycardia with ischemic cerebral changes, 1 of which required permanent pacemaking. All other patients had immediate resolution of their bradycardia, asystole, and neurologic symptoms immediately following balloon deflation and pharmaceutical management. There was a statistically significant difference in the observed proportion of bradycardic patients among COICA classifications (P = 0.014). There was no statistically significant difference in mean age between patients with bradycardia and those without (aged 63.36 vs. 67.71 years, P = 0.2265). CONCLUSIONS: Bradycardia associated with angioplasty of the carotid bulb was observed in the majority of patients receiving COICA revascularization. A small percentage of these patients were symptomatic. Our results suggest that carotid sinus baroreceptors remain active while residing in a complete arterial occlusion, and close monitoring is necessary during balloon angioplasty of the proximal COICA.

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Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

November 2019

Volume

131

Start / End Page

e211 / e217

Location

United States

Related Subject Headings

  • Pressoreceptors
  • Middle Aged
  • Male
  • Intraoperative Complications
  • Humans
  • Heart Arrest
  • Female
  • Endovascular Procedures
  • Collateral Circulation
  • Chronic Disease
 

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Hudson, J. S., Zanaty, M., Wadman, V., Nakagawa, D., Ishii, D., Roa, J. A., … Hasan, D. M. (2019). Bradycardia and Asystole in Patients Undergoing Symptomatic Chronically Occluded Internal Carotid Artery Recanalization. World Neurosurg, 131, e211–e217. https://doi.org/10.1016/j.wneu.2019.07.125
Hudson, Joseph S., Mario Zanaty, Victoria Wadman, Daichi Nakagawa, Daizo Ishii, Jorge A. Roa, Sami Al Kasabz, et al. “Bradycardia and Asystole in Patients Undergoing Symptomatic Chronically Occluded Internal Carotid Artery Recanalization.World Neurosurg 131 (November 2019): e211–17. https://doi.org/10.1016/j.wneu.2019.07.125.
Hudson JS, Zanaty M, Wadman V, Nakagawa D, Ishii D, Roa JA, et al. Bradycardia and Asystole in Patients Undergoing Symptomatic Chronically Occluded Internal Carotid Artery Recanalization. World Neurosurg. 2019 Nov;131:e211–7.
Hudson, Joseph S., et al. “Bradycardia and Asystole in Patients Undergoing Symptomatic Chronically Occluded Internal Carotid Artery Recanalization.World Neurosurg, vol. 131, Nov. 2019, pp. e211–17. Pubmed, doi:10.1016/j.wneu.2019.07.125.
Hudson JS, Zanaty M, Wadman V, Nakagawa D, Ishii D, Roa JA, Al Kasabz S, Limaye K, Rossen JD, Jabbour P, Adams HP, Samaniego EA, Hasan DM. Bradycardia and Asystole in Patients Undergoing Symptomatic Chronically Occluded Internal Carotid Artery Recanalization. World Neurosurg. 2019 Nov;131:e211–e217.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

November 2019

Volume

131

Start / End Page

e211 / e217

Location

United States

Related Subject Headings

  • Pressoreceptors
  • Middle Aged
  • Male
  • Intraoperative Complications
  • Humans
  • Heart Arrest
  • Female
  • Endovascular Procedures
  • Collateral Circulation
  • Chronic Disease