Download Sinus reaction during carotid stenting according to the carotid lesion

Sinus reaction during carotid stenting according to the carotid lesion type Jong Lim Kim, Dae Chul Suh, Jin-Ho Shin, Dong Ho Hyun, Ha Young Lee, Deok Hee Lee, Choong Gon Choi, Sang Joon Kim, Jong Sung Kim Departments of Radiology and Research Institute of Radiology, Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Korea

Carotid sinus reaction or hemodynamic instability · Carotid sinus reaction Post- and peri-procedural hypotension (SBP 20 beats/min) Hypertension (SBP > 160 mmHg) * Carotid stenosis location Apical Body

Park ST, et al. Am J Neuroradiol. 2010

I like to show that carotid sinus reaction can be associated with stenosis location Apical type stenosis in the left carotid bulb No carotid sinus reaction

Body type stenosis in the right carotid bulb Marked carotid sinus reaction

Carotid sinus

(anatomy & physiology)

· Ill-defined dilatation at the origin of the internal carotid artery D Heath. Thorax. 1983

· Monitoring and regulation of blood pressure Michael Doumas, et al. Expert Opin. Ther. Targets. 2009

Carotid sinus

(Embryology)

Common carotid artery and proximal part of internal carotid artery - Formed by remodeling of the third arch artery (yellow)

Baroreceptors (arrow) of the glossopharyngeal nerve - Distributed in proximal portion of internal carotid artery (carotid sinus)

Yoko Kameda. Cell Tissue Res. 2009

Carotid sinus nerve · Originating from the glossopharyngeal (IX) nerve

· Located in loose tissue close to the ICA wall Run parallel to or together with vagus nerve

· Ended in both carotid sinus & carotid body Toorop RJ, et al. J Vasc Surg. 2009

IX, glossopharyngeal nerve X, vagus nerve P, pharyngeal branches S, sympathetic trunk

Baroreflex · Major contributor to the homeostatic system of blood pressure control Michael Doumas, et al. Expert Opin. Ther. Targets. 2009

· Afferent fibres from carotid sinus baroreceptors join the

glossopharyngeal nerve and project to the nucleus tractus solitarii in the dorsal medulla, and in turn projects to efferent cardiovascular neurones in the medulla and spinal cord Timmers HJ et al. J Physiol. 2003

Arterial baroreflex loops Carotid sinus baroreceptors → glossopharyngeal nerve → medullary centres (nucleus tractus solitarii) → sympathetic and parasympathetic fibres to heart and blood vessels

Materials and Methods Prospective analysis 2007.01 ~ 2009.6 95 patients who underwent carotid stenting M : F = 82 : 12 Mean age : 69 years (38-89 years) Symptomatic carotid stenosis ≥ 50% (NASCET criteria)

Materials and Methods Transient sinus reaction :