Triggering of Carotid Sinus Reflex during Deployment of the Flow-diverter Device

A Case of Carotid Sinus Reflex Caused by Manual Aspiration Thrombectomy Using a Balloon Guide Catheter

When starting a mechanical thrombectomy, manual aspiration with balloon guide catheters inserted into the internal carotid artery (ICA) is an efficient method for thrombus aspiration. However, no complications associated with this procedure have been reported. This study describes the case of a 76-year-old man who presented to our hospital with total aphasia and complete right-sided paralysis due to chronic atrial fibrillation and left occlusion of the ICA. When the balloon guide catheter was inserted and inflated at the origin of the left ICA, the patient's systolic blood pressure suddenly decreased from 114 mm Hg to 44 mm Hg. This sudden hypotension may have been caused by the carotid sinus reflex. Hypotension improved following balloon deflation. The procedure was continued, resulting in complete recanalization of the left ICA. The patient died from acute exacerbation of interstitial pneumonia. Although this complication is rare, similar phenomena have been recognized in carotid artery stenting and the use of flow-diverting devices. To the best of our knowledge, this is the first report of a case wherein the carotid sinus reflex was induced by manual aspiration using a balloon guide catheter placed in the ICA. Clinicians should recognize the importance of ensuring that the proximal end of the balloon crosses the carotid sinus when dilating and occluding the ICA with a balloon to avoid the carotid sinus reflex.

Sudden cardiac arrest during endovascular embolization of carotid artery aneurysm: A case report and literature review

RATIONALE

Endovascular embolization has been widely applied in carotid artery aneurysm due to less trauma and simpler procedures than open surgery. Sudden cardiac arrest is a rare event that may cause severe consequences during endovascular embolization. Risk factors of perioperative cardiac arrest include cardiac surgery, younger age, comorbid conditions, and emergency surgery.

PATIENT CONCERNS

A 62-year-old male patient had hypertension for 15 years and experienced sudden cardiac arrest of pulseless electrical activity during endovascular embolization.

DIAGNOSES

He was diagnosed with a 3.5 × 2.5 mm aneurysm.

INTERVENTIONS

Chest compression and effective interventions were given.

OUTCOMES

He was resuscitated by cardiopulmonary resuscitation and systematic therapy.

LESSONS

This case may provide experience in the management of sudden cardiac arrest during endovascular embolization of a carotid artery aneurysm.