Key result
Carotid artery stenting causes bradycardia and hypotension via carotid sinus baroreceptor stimulation.
This review discusses the mechanisms and management of adverse hemodynamic changes, such as bradycardia and hypotension, during carotid artery stenting compared to open surgery.
Warrants close hemodynamic monitoring during carotid stenting; extends mechanistic understanding but leaves optimal prevention strategies open for trials.
Carotid artery interventions can be associated with adverse hemodynamic changes, including bradycardia and hypotension. These hemodynamic changes are believed to be caused by direct stimulation of the carotid sinus baroreceptors, mimicking normal physiological response to rises in blood pressure. During open carotid surgery, these hemodynamic changes can be controlled by direct injection of medications that block fast voltage gated sodium channels in the neuron cell membrane, thus preventing depolarization of the presynaptic neuron in the carotid sinus. This form of control is difficult or impossible during percutaneous carotid interventions because direct access to the carotid artery and carotid sinus is not available. This discussion focuses on the cause, effects, and possible treatments for the hemodynamic changes associated with carotid artery stenting procedures.
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Cayne et al. (2008) conducted a review in Hemodynamic changes associated with carotid artery interventions. Carotid artery interventions was evaluated. Carotid artery interventions, particularly stenting procedures, can cause adverse hemodynamic changes such as bradycardia and hypotension due to carotid sinus baroreceptor stimulation.
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