• Joseph S Hudson, Mario Zanaty, Victoria Wadman, Daichi Nakagawa, Daizo Ishii, Jorge A Roa, Sami Al Kasabz, Kaustubh Limaye, James D Rossen, Pascal Jabbour, Harold P Adams, Edgar A Samaniego, and David M Hasan.
• Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
• World Neurosurg. 2019 Nov 1; 131: e211-e217.

BackgroundReports have emerged describing the successful endovascular recanalization of the chronically occluded internal carotid artery (COICA). The impact this restoration of flow has on the sensitive carotid sinus baroreceptors has not been previously described. In this manuscript, we present the largest COICA surgical series to date, with a specific focus on perioperative heart rate abnormalities.MethodsPatient demographics were obtained, and the COICAs were radiographically classified based on the anatomic distribution of the stenosis and collateral flow. Thirty-six patients had a total of 37 COICA revascularization procedures.ResultsA total of 23 patients had intraprocedural bradycardia during balloon angioplasty. Three patients went into transient asystole during the procedure, and 2 of these patients had symptomatic bradycardia with ischemic cerebral changes, 1 of which required permanent pacemaking. All other patients had immediate resolution of their bradycardia, asystole, and neurologic symptoms immediately following balloon deflation and pharmaceutical management. There was a statistically significant difference in the observed proportion of bradycardic patients among COICA classifications (P = 0.014). There was no statistically significant difference in mean age between patients with bradycardia and those without (aged 63.36 vs. 67.71 years, P = 0.2265).ConclusionsBradycardia associated with angioplasty of the carotid bulb was observed in the majority of patients receiving COICA revascularization. A small percentage of these patients were symptomatic. Our results suggest that carotid sinus baroreceptors remain active while residing in a complete arterial occlusion, and close monitoring is necessary during balloon angioplasty of the proximal COICA.Copyright © 2019 Elsevier Inc. All rights reserved.

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