Carotid stent: Bradycardia cause

Physiology - Cardiovascular

During carotid angioplasty and stenting, a tiny balloon is inserted to widen the lumen of a stenotic carotid artery, and small metal stent is placed to prop it open and decrease the chance of restenosis. During and after this procedure, the normal carotid baroreceptor reflex mechanism may produce a physiologically-inappropriate response.

This reflex can be triggered when baroreceptors in the carotid sinus are stretched by the balloon and stent. This may cause a sudden inappropriate bradycardia and systemic hypotension, and these patients may require immediate treatment to restore normal heart rate and blood pressure. The vagolytic action of anticholinergic drugs like atropine and glycopyrrolate can be effective in reversing or preventing unwanted bradycardia. Some anesthesiologists will administer medication preemptively in anticipation of carotid sinus stimulation.

The risk of bradycardia and hypotension after carotid stenting is directly related to the degree of dilation performed and may be observed up to twelve hours postoperatively[1]. Postoperative hypotension correlates with increased in-hospital complications and long-term risk of death[2].

Sources

    AJNR Am J Neuroradiol;2008 Nov;29(10):1942-7

    [PubMed: 18719034]

    Radiology;2000 Jun;215(3):677-83

    [PubMed: 10831683]

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Answered correctly

2010

Year asked

Author
Jacob Nadler, MD, PhD