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
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Sinus reaction during carotid stenting according to the carotid lesion type
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 - PowerPoint PPT Presentation
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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 in-stability
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 con-
trol Michael Doumas, et al. Expert Opin. Ther. Targets. 2009
· Afferent fibres from carotid sinus baroreceptors join the glos-sopharyngeal nerve and project to the nucleus tractus soli-tarii 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)
Comparison of Significant Difference of Transient Sinus Reac-tion
* Stepwise logistic regression to eliminate confounding factor reveals that length is true independent factor (P = 0.002)
Results
Apical (n=56) Body (n=39) P-valve
SBP>160< 3 h 12 8 0.914
3 - 24 h 7 5 1
Event1m 5 0 0.076
6m 0 1 0.411
Hyperperfusion 6 2 0.464
Restenosis 1 3 0.302
Case 1Age/sex M/63Location right
Transient sinus reaction +Lesion type Body
Length of maximum stenosis from the ICA ostium* (mm) 2.24
Case 2
Age/sex M/77Location right
Transient sinus reaction -Lesion type Apical
Length of maximum stenosis from the ICA ostium* (mm) 14.53
Case 3
Age/sex M/85Location right
Transient sinus reaction -Lesion type Apical
Length of maximum stenosis from the ICA ostium* (mm) 16.67
Hyperperfusion +
Summary and conclusion1. Sinus reaction in carotid stenting is different in two distinct locations, body and apical portion of carotid bulb
2. Body lesion type was more vulnerable to sinus reaction than apical
lesion type ① Related to anatomical baroreceptor disposition in carotid sinus * Baroreceptors are located in the carotid sinus of carotid bulb Such embryological implication appeared to affect carotid bulb lesion type ② Induced preventive effect for high blood pressure which might contribute
to hyperperfusion syndrome → Less common to hyperperfusion syndrome
3. Apical lesion type had higher event rate than body lesion type
① Associated with more common periprocedural hypertension → Needs more careful management of blood pressure control for apical