title: Implications of carotid sinus hypersensitivity following preoperative embolization of a carotid body tumor. An indication for prophylactic intraoperative cardiac pacing.
abstract: IMPORTANCE Carotid body tumors are rare neoplasms of neural crest origin that are both highly vascularized and locally invasive. Treatment options for these tumors often include surgery with preoperative embolization, which can pose major cardiovascular risk to patients. As demonstrated by this case report, hemodynamic instability following preoperative embolization of a carotid body tumor may indicate severe carotid sinus hypersensitivity and the need for temporary cardiac pacing. OBSERVATIONS This case report describes a man in his early 30s who presented for staged surgical resection of bilateral carotid body tumors with preoperative embolization. After embolization of the second tumor, the patient displayed transient episodes of bradycardia and hypotension, which resolved with medical management. Surgery commenced, and with minimal manipulation intraoperatively, the patient became asystolic and required resuscitation. Following a negative cardiac workup, a temporary pacemaker was implanted, and surgical resection of the tumor was successfully completed. CONCLUSIONS AND RELEVANCE Carotid sinus hypersensitivity is a rare but serious risk of preoperative embolization of carotid body tumors. Postembolization bradycardia or hypotension should be assessed as potential harbingers of carotid sinus hypersensitivity, and the need for temporary intraoperative cardiac pacing should be strongly considered.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Bauer
authors.forename: Russell B
authors.initials: RB
authors.lastname: Smith
authors.forename: William E
authors.initials: WE
authors.lastname: Thorell
mesh_terms: D000328:Adult; D000792:Angiography; D001919:Bradycardia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002345:Carotid Body Tumor / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002346:Carotid Sinus / Q000503:physiopathology*; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D010138:Pacemaker, Artificial; D011300:Preoperative Care / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*