Clinical Results of Carotid Denervation by Adventitial Stripping in Carotid Sinus Syndrome

Aims: 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%). Conclusion: 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. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.