Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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The efficacy and efficiency of percutaneous lidocaine injection for minimizing the carotid reflex in carotid artery stenting: A single-center retrospective study

  • Hyung Kyu Lee (Department of Neurosurgery, Cheju Halla General Hospital) ;
  • Tae Joon Park (Department of Neurosurgery, Cheju Halla General Hospital) ;
  • Sang Pyung Lee (Department of Neurosurgery, Cheju Halla General Hospital) ;
  • Jin Wook Baek (Department of Neurosurgery, Cheju Halla General Hospital) ;
  • Seong Hwan Kim (Department of Neurosurgery, Cheju Halla General Hospital) ;
  • Aiden Ryou (Rancho Bernardo High School)
  • Received : 2023.06.22
  • Accepted : 2023.09.18
  • Published : 2024.06.30
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Abstract

Objective: To assess whether local anesthetic infiltration could minimize the carotid baroreceptor reflex (CBR) which has an incidence after carotid artery stenting (CAS) that varies from 29% to 51%. Methods: This retrospective single-center study included 51 patients (mean age, 70.47 years) who underwent CAS for carotid stenosis. The groups included patients who underwent CAS for asymptomatic ischemic stroke (n=41) or symptomatic disease (n=10). Preprocedural percutaneous lidocaine injections (PPLIs) were administered to 70.6% and 5.9% of patients who underwent elective CAS and emergency CAS, respectively. Results: Among patients who received PPLIs, the mean degree of stenosis was 80.5% (95% confidence interval [CI]: ±10.74, 51-98%). The mean distance from the common carotid artery bifurcation to the most stenotic lesion (CSD) was 8.3 mm (95% CI: ±0.97, 6.3-10.2 mm); the mean angle between the internal carotid artery and common carotid artery (CCA) trunk (IAG) was 65.6° (95% CI: ±2.39, 61-70°). Among patients who did not receive PPLIs, the mean degree of stenosis was 84.0% (95% CI: ±8.96, 70-99%). The mean CSD was 5.9 mm (95% CI: ±1.83, 1.9-9.9 mm); the mean IAG was 60.4° (95% CI: ±4.41, 51-70°). The procedure time was longer in the PPLI group than in the no PPLI group (28.19 [n=39] vs. 18.88 [n=12] days) (P=0.057); the length of intensive care unit stay was shorter in the PPLI group (20.01 [n=36] vs. 28.10 [n=5] days) (P=0.132). Conclusions: Targeted PPLI administration to the carotid bulb decreased aberrant heart rates and blood pressure changes induced by carotid stent deployment and balloon inflation. As CBR sensitivity increases with decreasing distance to the stenotic lesion from the CCA bifurcation, PPLIs may help stabilize patients during procedures for stenotic lesions closer to the CCA.

Keywords

Acknowledgement

We would like to thank Editage (www.editage.co.kr) for English language editing.

References

  1. Abbott AL, Paraskevas KI, Kakkos SK, Golledge J, Eckstein HH, Diaz-Sandoval LJ, et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke. 2015 Nov;46(11):3288-301. 
  2. Ajduk M, Tudoric I, Sarlija M, Pavic P, Oremus Z, Held R, et al. Effect of carotid sinus nerve blockade on hemodynamic stability during carotid endarterectomy under local anesthesia. J Vasc Surg. 2011 Aug;54(2):386-93. 
  3. Al-Rawi PG, Sigaudo-Roussel D, Gaunt ME. Effect of lignocaine injection in carotid sinus on baroreceptor sensitivity during carotid endarterectomy. J Vasc Surg. 2004 Jun;39(6):1288-94. 
  4. Bonati LH, Kakkos S, Berkefeld J, de Borst GJ, Bulbulia R, Halliday A, et al. European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J. 2021 Jun;6(2):I-XLVII. 
  5. Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W, et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016 Mar;374(11):1021-31. 
  6. Cao Q, Zhang J, Xu G. Hemodynamic changes and baroreflex sensitivity associated with carotid endarterectomy and carotid artery stenting. Interv Neurol. 2015 Jan;3(1):13-21. 
  7. Cayne NS, Faries PL, Trocciola SM, Saltzberg SS, Dayal RD, Clair D, et al. Carotid angioplasty and stent-induced bradycardia and hypotension: Impact of prophylactic atropine administration and prior carotid endarterectomy. J Vasc Surg. 2005 Jun;41(6):956-61. 
  8. De Rango P, Parlani G, Verzini F, Giordano G, Panuccio G, Barbante M, et al. Long-term prevention of stroke: A modern comparison of current carotid stenting and carotid endarterectomy. J Am Coll Cardiol. 2011 Feb;57(6):664-71. 
  9. Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: A multinational, prospective, randomised trial. TLancet Neurol. 2008 Oct;7(10):893-902 
  10. European Stroke Organisation; Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, et al. ESC guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011 Nov;32(22):2851-906. 
  11. Fox AJ, Eliasziw M, Rothwell PM, Schmidt MH, Warlow CP, Barnett HJ. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am J Neuroradiol. 2005 Sep;26(8):2086-94. 
  12. George JC, White CJ. Carotid artery stenting: Lessons from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). JACC Cardiovasc Interv. 2010 Sep;3(9):988-90. 
  13. Gray WA, Yadav JS, Verta P, Scicli A, Fairman R, Wholey M, et al. The CAPTURE registry: Results of carotid stenting with embolic protection in the post approval setting. Catheter Cardiovasc Interv. 2007 Feb;69(3):341-8. 
  14. Gupta R, Horowitz M, Jovin TG. Hemodynamic instability after carotid artery angioplasty and stent placement: A review of the literature. Neurosurg Focus. 2005 Jan;18(1):e6. 
  15. Komotar RJ, Starke RM, Connolly ES. Carotid endarterectomy vs endovascular stenting: Recent results from ICSS and CREST. Neurosurgery. 2010 Jun;66(6):N12-3. 
  16. Lau EO, Lo CY, Yao Y, Mak AF, Jiang L, Huang Y, et al. Aortic baroreceptors display higher mechanosensitivity than carotid baroreceptors. Front Physiol. 2016 Aug;7:384. 
  17. Leisch F, Kerschner K, Hofmann R, Steinwender C, Grund M, Bibl D, et al. Carotid sinus reactions during carotid artery stenting: Predictors, incidence, and influence on clinical outcome. Catheter Cardiovasc Interv. 2003 Apr;58(4):516-23. 
  18. Levy M, Pappano A, Berne R. Cardiovascular physiology. Philadelphia, PA: Mosby Elsevier, 2007. 
  19. Lim HH, Ho KM, Choi WY, Teoh GS, Chiu KY. The use of intravenous atropine after a saline infusion in the prevention of spinal anesthesia-induced hypotension in elderly patients. Anesth Analg. 2000 Nov;91(5):1203-6. 
  20. Lin PH, Zhou W, Kougias P, El Sayed HF, Barshes NR, Huynh TT. Factors associated with hypotension and bradycardia after carotid angioplasty and stenting. J Vasc Surg. 2007 Nov; 46(5):846-53; discussion 853-4. 
  21. Maher CO, Wetjen NM, Friedman JA, Meyer FB. Intraoperative lidocaine injection into the carotid sinus during endarterectomy. J Neurosurg. 2002 Jul;97(1):80-3. 
  22. Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: Results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008 Oct;7(10):885-92. 
  23. McKevitt F, Randall M, Cleveland T, Gaines P, Tan K, Venables G. The benefits of combined anti-platelet treatment in carotid artery stenting. Eur J Vasc Endovasc Surg. 2005 May;29(5):522-7. 
  24. Mourikis D, Chatoupis K, Katsenis K, Vlahos L, Chatziioannou A. Percutaneous injection of lidocaine within the carotid body area in carotid artery stenting: An "old-new" technique. Cardiovasc Intervent Radiol. 2008 Jul-Aug;31(4):709-12. 
  25. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991 Aug;325(7):445-53. 
  26. Park JH, Lee JH. Carotid artery stenting. Korean Circ J. 2018 Feb;48(2):97-113. 
  27. Pujia A, Rubba P, Spencer MP. Prevalence of extracranial carotid artery disease detectable by echo-Doppler in an elderly population. Stroke. 1992 Jun;23(6):818-22. 
  28. Qureshi AI, Luft AR, Sharma M, Janardhan V, Lopes DK, Khan J, et al. Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting. Stroke. 1999 Oct;30(10):2086-93. 
  29. Stallard S, Prescott S. Postoperative urinary retention in general surgical patients. Br J Surg. 1988 Nov;75(11):1141-3. 
  30. Suh D, Kim J, Kim E, Kim J, Shin JH, Hyun D, et al. Carotid baroreceptor reaction after stenting in 2 locations of carotid bulb lesions of different embryologic origin. AJNR Am J Neuroradiol. 2012 May;33(5):977-81. 
  31. Towne JB, Bernhard VM. The relationship of postoperative hypertension to complications following carotid endarterectomy. Surgery. 1980 Oct;88(4):575-80. 
  32. Zhu Z, Yu W. Update in the treatment of extracranial atherosclerotic disease for stroke prevention. Stroke Vasc Neurol. 2019 Nov;5(1):65-70.