Prevention of carotid angioplasty-induced @entity1168 and XXXX with temporary venous pacemakers.

@entity1 @entity341 @entity2998 @entity453 @entity850 @entity551 @entity1168
OBJECTIVE: Carotid angioplasty with stent placement is becoming an established treatment modality for @entity1 with high-risk carotid @entity850 . Unlike carotid endarterectomy, angioplasty causes direct mechanical dilation of the stenotic carotid artery and bulb. Stimulation of the sinus baroreceptors induces a reflexive response that consists of increased parasympathetic discharge and inhibition of sympathetic tone, which results in @entity1168 and subsequent cardiogenic @entity551 . METHODS: At a single institution, the experience with 43 @entity1 treated from November 1994 to January 2000 with 47 angioplasty and stent procedures for occlusive @entity2998 was retrospectively reviewed. Prophylactic temporary venous pacemakers were used to prevent @entity551 from possible angioplasty-induced @entity1168 . Pacemakers were set to capture a heart rate decrease below 60 beats per minute. Variables analyzed included demographics, etiology of disease, side of the lesion, the presence of symptoms, history of @entity453 , percent @entity850 , type of stent used, number of dilations, pressure of dilation, and angioplasty balloon diameter. RESULTS: Ten @entity1 were excluded because pacemakers were not used during their angioplasty procedures, and these included three @entity341 and a lesion that was unrelated anatomically to the carotid sinus (petrous carotid). The remaining 37 procedures were performed in 33 @entity1 with a mean age of 67 years, and consisted of 17 @entity1 , 16 @entity1 , 20 right and 17 left-sided lesions. The pacemakers maintained a cardiac rhythm in 23 (62%) of the 37 procedures and in no case did the pacemaker fail to respond when activated. Recurrent (56%; 10 of 18), radiation-induced (78%; 7 of 9), and medically refractory carotid @entity850 (67%; 6 of 9) required intraprocedural pacing. Two @entity1 with recurrent @entity850 became @entity551 despite the aid of the pacing device but were not symptomatic. Seventy-nine percent (15 of 19) of symptomatic lesions and 57% (8 of 14) of nonsymptomatic lesions required pacing, which was statistically significant (P = 0.049). No @entity1 experienced an operative morbidity or mortality as a consequence of the temporary pacing devices. CONCLUSION: Angioplasty-induced @entity1168 is a common condition, and it is more prevalent in radiation-induced @entity850 and with symptomatic lesions. Temporary venous demand pacing is a safe procedure and may prevent life-threatening, baroreceptor-induced @entity551 .
