Clinical results of carotid denervation by adventitial stripping in carotid sinus syndrome.
OBJECTIVE
Older patients with spells of syncope may suffer from a carotid sinus syndrome (CSS). Patients with invalidating CSS routinely receive pacemaker treatment. This study evaluated the safety and early outcome of a surgical technique termed carotid denervation by adventitial stripping for CSS treatment.


METHODS
Carotid sinus massage (CSM) during cardiovascular monitoring confirmed CSS in patients with a history of repeated syncope and dizziness. The internal carotid artery was surgically denervated by adventitial stripping over a minimum distance of 3 cm via a standard open approach. Patient characteristics, perioperative complications and 30-day success rate were analyzed.


RESULTS
A total of 39 carotid denervation procedures was performed in 27 individuals (23 males, mean age 70+/-3 years) between 1980 and 2007 in a single institution. Eleven patients had a bilateral hypersensitive carotid sinus. Procedure related complications included wound hematoma (n=4), neuropraxia of the marginal mandibular branch of the facial nerve (n=2) and dysrhythmia responding to conservative treatment (n=3). Significant alterations in systolic and diastolic blood pressure and heart rate were not observed. One patient developed a cerebral ischaemic vascular accident on the 24th postoperative day. One patient with residual disease had a successful redenervation within 1 month after the initial operation. Two patients with persistent symptoms received a pacemaker but also to no avail. At 30-day follow up 25 of 27 patients (93%) were free of syncope, and 24 free of a pacemaker (89%).


CONCLUSIONS
Carotid denervation by adventitial stripping of the proximal carotid internal artery is effective and safe and may offer a valid alternative for pacemaker treatment in patients with carotid sinus syndrome.
Toorop
R J
RJ
Department of Vascular Surgery, University Medical Center, PO Box 85500, 3508 GA, Utrecht, The Netherlands. rtoorop@yahoo.com
Scheltinga
M R
MR
Huige
M C
MC
Moll
F L
FL
D000368:Aged; D017763:Autonomic Denervation / Q000379:methods*; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002346:Carotid Sinus / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D003238:Connective Tissue / Q000601:surgery*; D004244:Dizziness / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications; D013575:Syncope / Q000209:etiology / Q000503:physiopathology; D013577:Syndrome; D016896:Treatment Outcome