• Shunsaku Goto, Takashi Izumi, Masahiro Nishihori, Mamoru Ishida, Tetsuya Ishida, Masato Otawa, Tomoki Kawaguchi, Ryosuke Oshima, Asuka Kropp, Mizuka Ikezawa, and Toshihiko Wakabayashi.
• Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
• World Neurosurg. 2019 Apr 1; 124: 222422-24.

BackgroundA 60-year-old female with multiple carotid aneurysms underwent endovascular treatment with a Pipeline Flex embolization device (PED) under local anesthesia via femoral puncture.Case DescriptionCardiac arrest occurred when the delivery systems were pushed to promote adequate opening and apposition of the PED against the vessel wall and was recovered to sinus rhythm in approximately 30 seconds by pulling down the microcatheter. The carotid sinus reflex was suspected as the cause of this temporary asystole. Delivery of the PED was accompanied by application of forward pressure on the delivery system. This resulted in buckling of the delivery systems in the neck and likely excessive pressure on the carotid sinus. The procedure was continued and successfully completed with care not to excessively push the system and with the additional use of atropine.ConclusionsAlthough it was a rare complication, the phenomenon and its mechanisms were known in the carotid artery stenting procedure. To the best of our knowledge, this is the first report of cardiac arrest induced by a carotid sinus reflex during PED deployment. It is important for an operator of PED deployment to recognize its possibility. Vital signs should be closely checked during PED deployment, particularly while pushing the catheter.Copyright © 2019 Elsevier Inc. All rights reserved.

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