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

Joseph S Hudson; Mario Zanaty; Victoria Wadman; Daichi Nakagawa; Daizo Ishii; Jorge A Roa; Sami Al Kasabz; Kaustubh Limaye; James D Rossen; Pascal Jabbour; Harold P Adams Jr; Edgar A Samaniego; David M Hasan

doi:10.1016/j.wneu.2019.07.125

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

Journal article

Peer reviewed

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

Joseph S Hudson, Mario Zanaty, Victoria Wadman, Daichi Nakagawa, Daizo Ishii, Jorge A Roa, Sami Al Kasabz, Kaustubh Limaye, James D Rossen, Pascal Jabbour, …

World neurosurgery, Vol.131, pp.e211-E217

11/2019

DOI: 10.1016/j.wneu.2019.07.125

PMID: 31349074

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Abstract

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. 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. 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). 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.

Intraoperative Complications - epidemiology

Carotid Stenosis - classification

Humans

Middle Aged

Carotid Stenosis - therapy

Collateral Circulation

Heart Arrest - epidemiology

Endovascular Procedures

Male

Pressoreceptors

Bradycardia - epidemiology

Aged, 80 and over

Female

Aged

Angioplasty, Balloon

Carotid Stenosis - diagnostic imaging

Chronic Disease

Carotid Sinus

Details

Title: Subtitle: Bradycardia and Asystole in Patients Undergoing Symptomatic Chronically Occluded Internal Carotid Artery Recanalization
Creators: Joseph S Hudson - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Mario Zanaty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Victoria Wadman - College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
Daichi Nakagawa - Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
Daizo Ishii - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Jorge A Roa - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Sami Al Kasabz - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Kaustubh Limaye - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
James D Rossen - Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Pascal Jabbour - Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
Harold P Adams Jr - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Edgar A Samaniego - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
David M Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Electronic address: david-hasan@uiowa.edu
Resource Type: Journal article
Publication Details: World neurosurgery, Vol.131, pp.e211-E217
Publisher: United States
DOI: 10.1016/j.wneu.2019.07.125
PMID: 31349074
ISSN: 1878-8750
eISSN: 1878-8769
Language: English
Date published: 11/2019
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Cardiovascular Medicine; Neurosurgery; Otolaryngology; Internal Medicine
Record Identifier: 9984070551802771

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