Key result
Carotid sinus reaction during internal carotid artery angioplasty significantly increased the risk of intraprocedural syncope (OR 4.2), which was predominantly cardioinhibitory and frequently accompanied by convulsive movements.
Observational (n=359)
No
Odds Ratio: 4.2 (95% CI 1.9–9.1)
Absolute Event Rate: 24% vs 7.4%
p-value: p=<0.001
Syncope is a frequent complication during internal carotid artery angioplasty, primarily driven by a cardioinhibitory response, and often presents with convulsive movements that can be misdiagnosed as seizures.
Alerts operators to cardioinhibitory syncope with convulsive features during carotid angioplasty; leaves open optimal prevention strategies for prospective trials.
BACKGROUND AND PURPOSE: Carotid sinus syncope may occur acutely during internal carotid artery angioplasty (CA). We performed this study to investigate the clinical, electroencephalographic (EEG), and hemodynamic features of carotid sinus syncope induced by CA. MATERIALS AND METHODS: Between 1992 and 2003, clinical, EEG, and cardiovascular monitoring was performed in 359 consecutive patients undergoing CA. RESULTS: Carotid sinus reaction (CSR) and syncope occurred in 62.7% and 18.6% of the procedures, respectively. CSR and syncopal spells were classified into cardioinhibitory, vasodepressor, and mixed type. Syncope occurred more frequently in patients with cardioinhibitory CSR (P < .001). The odds ratios for the risk of syncope in patients with cardioinhibitory CSR and vasodepressor/mixed CSR were 6.9 and 1.4, respectively. Sixty-one patients had cardioinhibitory syncope; 7 had the vasodepressor/mixed type. Thirteen spells were not related to cardiovascular disturbances. This last syncope subtype was significantly associated with brain hemodynamic disturbances, including a decrease in cerebral vasoreactivity (P = .04) and the absence of function of both communicating arteries (P = .03). Convulsive movements resembling supplementary sensorimotor seizures occurred in 79% of patients who experienced syncopal spells. EEG changes were more prominent in patients with cardioinhibitory syncope. CONCLUSIONS: Syncope occurs frequently in patients undergoing CA and can be misdiagnosed as seizures. The most frequent mechanism was a cardioinhibitory response. Cerebral hemodynamic disturbances may play a crucial role in the pathophysiology of syncope with normal sinus rhythm and normotension. Moreover, direct depression of the CNS following carotid sinus distension is likely to be involved.
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Martínez-Fernández et al. (2007) conducted an observational in Internal carotid artery stenosis (n=359). Carotid sinus reaction during internal carotid artery angioplasty vs. No carotid sinus reaction was evaluated on Occurrence of syncope during internal carotid artery angioplasty (OR 4.2, 95% CI 1.9-9.1, p=<0.001). Carotid sinus reaction during internal carotid artery angioplasty significantly increased the risk of intraprocedural syncope (OR 4.2), which was predominantly cardioinhibitory and frequently accompanied by convulsive movements.
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