Long Term Safety and Efficacy of Internal Carotid Artery Adventitial Stripping in Carotid Sinus Syndrome

Background: To investigate the long term efficacy of carotid denervation by adventitial stripping of the internal carotid artery (ICA) for carotid sinus syndrome (CSS). Secondly, the long term safety of this technique is investigated with emphasis on the effects on blood pressure (BP), heart rate (HR) and carotid artery diameter. Methods: Characteristics of patients that were operated for CSS in a single institute between 1980-2007 were studied by a retrospective chart review. Alive and fit patients additionally received a standardized interview investigating symptoms of residual CSS or baroreflex failure. They underwent a test panel consisting of office BP measurement, carotid sinus massage (CSM), table tilt testing, 24-hour ECG and ambulatory BP measurement (ABPM) and carotid duplex. Unoperated, age-and sex-matched individuals without CSS served as controls. Results: After a total follow up of 91 +/- 34 months, 22 of 26 patients (85%) were asymptomatic and 20 of them (77%) without a pacemaker. Of the 7 surviving and fit patients, six were free of CSS symptoms (follow up 114 +/- 81 months). Recurrence of CSS after an initial successful carotid denervation was not observed. BP level, BP variability and carotid diameters were not different compared to controls. Conclusion: Carotid denervation by adventitial stripping of the ICA for CSS seems effective and safe on the long term. A randomized controlled trial comparing the efficacy and safety of carotid denervation, pacing and medical treatment is needed for optimal future treatment of patients suffering from CSS.