ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 4 (2021), SELECTED ISSUES IN ANESTHESIOLOGY
No. 4 (2021)
SELECTED ISSUES IN ANESTHESIOLOGY

Blockade of the carotid sinus in endovascular surgery of the internal carotid arteries: why and to whom? Prospective single-center study

Published 19.01.2022
R.V. Polishchuk
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0003-2850-3999
M.A. Piradov
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0002-6338-0392
Yulia V. Ryabinkina
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0001-8576-9983
V.L. Shchipakin
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0003-1428-2769
A.Yu. Koshcheev
Research Center of Neurology, Moscow, Russia
https://orcid.org/0000-0003-0160-7499
#2021-4
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Keywords

carotid stenosis
carotid sinus
syncope
baroreceptor reflex
asystole
hypotension
balloon angioplasty
stents
nerve block

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1.
Polishchuk R.V., Piradov M.A., Ryabinkina Y.V., Shchipakin V.L., Koshcheev A.Y. Blockade of the carotid sinus in endovascular surgery of the internal carotid arteries: why and to whom? Prospective single-center study. Annals of Critical Care. 2022;(4):106-114. doi:10.21320/1818-474X-2021-4-106-114
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Abstract

Introduction. The widespread use of transluminal balloon angioplasty with stenting of the internal carotid arteries as part of the prevention of ischemic stroke has led to an increase in the number of publications in the world literature indicating the development of carotid sinus syndrome (“hemodynamic instability”) in the perioperative period, cerebral and cardiac complications, and deaths. requires the development of other approaches to providing medical care to patients with atherosclerotic carotid stenosis. Objectives. To assess the efficacy and safety of carotid sinus blockade when performing angioplasty with stenting of the internal carotid arteries and to determine indications for its implementation. Materials and Methods. The study included 120 patients with atherosclerotic stenosis of the internal carotid arteries who underwent transluminal balloon angioplasty with stenting. 60 of them underwent carotid sinus blockade. Results. The incidence of SCS in the group of patients with BCS was 68.3 % (n = 41) versus 71.6 % (n = 43) in the group of patients without BCS (p > 0.05). However, none of the patients who underwent BCS had asystole and AV block (p < 0.05). With vasodepressor and cardio-inhibitory types, there is no significant difference in the time of occurrence of SCS between the groups (p > 0.05). With the most frequently developing type of SCS, mixed, the incidence of SCS with balloon dilatation is significantly lower with BCS — 16.7 % (BCS) versus 83.3 % (without BCS) (p < 0.05). When performing BCS in the group without SCS, in all cases there was no contralateral occlusion of the ICA (p < 0.05). Conclusions. BCS does not prevent the development of SCS, but eliminates such life-threatening complications as asystole and AV block. BCS can be indicated in patients with a history of cardiac pathology and is inappropriate for contralateral carotid occlusion.

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