Carotid Artery Stenosis in Syncope and in Carotid Sinus Syndrome: A Few Concepts for the General Practitioner to Know

Introduction. Significant progress has been made in primary stroke prevention, including through the widespread use of carotid angioplasty with stenting (CAS). At the same time, there is a growing number of publications reporting the development of carotid sinus syndrome (CSS) (haemodynamic instability) in the periope- rative period, as well as cerebral and cardiac complications and death, which requires in-depth study to improve the quality of medical care for patients with carotid artery stenosis. The aim of the study was to determine the frequency, risk factors, clinical features and outcomes of CSS in patients with carotid artery stenosis undergoing CAS. Materials and methods. The study included 120 patients with carotid artery disease, who underwent an elective surgical intervention consisting of transluminal balloon angioplasty. All patients underwent comprehensive clinical and laboratory tests and imaging studies. Results. CSS developed in 70% of cases (n = 84) of carotid artery stenosis, and was significantly more common in men than women (71.4% vs. 28.6%, respectively) (p 0.05). The median age of all patients with CSS was 68 (4491) years. Mixed form of CSS was significantly more common than the cardioinhibitory or vasodepressor forms (p 0.05). In more than half of all cases, symptoms developed during balloon dilatation or within an hour afterwards. The duration of CSS was 3040 hours. Contralateral carotid occlusion was detected in 12 (10%) patients, significantly (p 0.05) more often in patients with CSS (13%) compared to patients without CSS (2.8%). Conclusion. Regardless of stenosis severity or symptoms, CAS is accompanied by CSS in 2/3 of cases. The CSS is predominantly a mixed type and can be accompanied by loss of consciousness in rare cases. CSS appears both intraoperatively and in the early postoperative period, and its average duration is 1.5 days. A factor that may be associated with CSS development is contralateral carotid artery occlusion (p 0.05).

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Ischemic stroke secondary to self-inflicted carotid sinus massage: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02680-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Edgar R. Lopez-Navarro ◽

Götz Greif ◽

Carl-Albrecht Haensch ◽

Adrian Ringelstein ◽

Robert Larbig

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Stroke Unit ◽

Carotid Sinus ◽

White Male ◽

Magnetic Resonance Images ◽

Artery Stenosis ◽

Carotid Sinus Massage

Abstract Background The risk of stroke after carotid sinus massage is greater if there is preexisting carotid stenosis or carotid plaques. We present the case of a patient with underlying 40% carotid stenosis, who developed a watershed stroke after a self-neck massage in our stroke unit. We show a well-documented case with magnetic resonance images before and after the neck massage. We report a case of a watershed brain infarct after a self-massage of the carotid sinus, with preexisting carotid artery stenosis. Neck massage continues to be a significant cause of stroke and should therefore not be performed by patients. Clinicians must be aware of the implications of a carotid sinus massage in both the outpatient and inpatient settings. Case presentation We admitted a 58-year-old white male patient, with no relevant medical history, to our department with a brain stem infarct. During his stay at our stroke unit, the patient performed a self-neck massage with consecutive bradycardia and asystole, resulting in left-side hemiparesis. The underlying cause of the hemodynamic stroke is believed to be secondary to this intensive neck massage performed by the patient. The patient also suffered from unknown right internal carotid artery stenosis. Conclusion Clinicians and patients must be aware that neck massage can lead to ischemic stroke. We postulate that repetitive impaired cardiac output can lead to a hemodynamic (watershed-type) stroke.

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Carotid Atherosclerosis Assessment Using Ultrasonography – Making it an Easy and Valuable Tool for the General Practitioner

Internal Medicine ◽

10.2478/inmed-2021-0148 ◽

2021 ◽

Vol 18 (1) ◽

pp. 23-33

Author(s):

Raluca Popa ◽

Cristina Stănescu ◽

Dan Stănescu ◽

Adriana Gurghean

Keyword(s):

General Practitioner ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Atherosclerosis ◽

Duplex Ultrasound ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Asymptomatic Carotid Artery Stenosis

Abstract The thromboembolism of an asymptomatic carotid artery stenosis (CAS) causes stroke in 10-15% cases and in Europe, stroke causes more than 1 million deaths a year. This important cause of mortality may be evaluated by duplex ultrasound (DUS). In five decades of experience, carotid DUS has proven to be a risk -free procedure, being widely available, easy to use, inexpensive, painless and quite reproducible. The purpose of this article was to try to extend the usual indications of DUS assessment of carotid atherosclerosis (CA) in order to offer a tool for less experienced ultrasonographers to gather useful information for optimizing patient’s management. We tried to review the literature and to provide a simple, easy to apply algorithm for estimating the presence and severity of CA.

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Carotid artery stenosis detected by ultra-sonography-does correlate with anatomic findings R.-G. Ricardo, A. Jorge, V. Ricardo, M. Rolando. Hospital Universitario, U.A.N.L. Monterrey, N.L. Mexico

European Journal of Ultrasound ◽

10.1016/s0929-8266(97)90034-3 ◽

1997 ◽

Vol 5 ◽

pp. 13-14

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis

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Methods for Improvement of Velocity Measurement for Carotid Artery Stenosis Estimation

European Journal of Ultrasound ◽

10.1016/s0929-8266(97)87277-1 ◽

1997 ◽

Vol 6 ◽

pp. S40

Author(s):

P Hoskins

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Velocity Measurement ◽

Artery Stenosis

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Oxidative injury associated with stenting of asymptomatic carotid artery stenosis

VASA ◽

10.1024/0301-1526/a000621 ◽

2017 ◽

Vol 46 (4) ◽

pp. 268-274

Author(s):

Erhan Saraçoğlu ◽

Ertan Vuruşkan ◽

Yusuf Çekici ◽

Salih Kiliç ◽

Halil Ay ◽

...

Keyword(s):

Oxidative Stress ◽

Carotid Artery ◽

Oxidative Damage ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Oxidative Stress Marker ◽

Asymptomatic Carotid ◽

Imaging Methods ◽

Neurological Findings ◽

Asymptomatic Carotid Artery Stenosis

Abstract. Background: After carotid artery stenting (CAS), neurological complications that cannot be explained with imaging methods may develop. In our study we aimed to show, using oxidative stress markers, isolated oxidative damage and resulting neurological findings following CAS in patients with asymptomatic carotid artery stenosis. Patients and methods: We included 131 neurologically asymptomatic patients requiring CAS. The neurological findings were evaluated using the modified Rankin Scale (mRS) prior to the procedure, one hour post-procedure, and two days after. Patients with elevated mRS scores but with or without typical hyperintense lesions observed on an MRI and with changes of oxidative stress marker levels at the time (Δtotal-thiol, Δtotal antioxidative status [TAS], and Δtotal oxidant status [TOS]) were evaluated. Results: In the neurological examination carried out one hour prior to the procedure, there were 92 patients with mRS = 0, 20 with mRS = 1, and 12 with mRS = 2. When Δtotal-thiol, ΔTAS, and ΔTOS values and the mRS were compared, it was observed that as the difference in oxidative parameters increased, clinical deterioration also increased proportionally (p = 0.001). Conclusions: We demonstrate a possible correlation between oxidative damage and neurological findings after CAS which could not be explained by routine imaging methods.

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