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Background. The Carotid Sinus Syndrome (CSS) is a rare condition causing spontaneous syncopal attacks or marked dizziness.
Methods. We studied 28 patients affected by CSS from January 1991 to October 1996. Eleven patients affected by cardioinhibitory type were treated by pace-maker (PM) implant. Seventeen patients had mixed type and all, but one who refused any treatment, entered this study. Carotid Sinus Denervation (CSD) was first performed in 2 of 10 patients who remained symptomatic after PM and in 6 patients as first choice therapy.
Results. At a mean follow-up of 30 months no patient submitted to CSD had recurrent syncopal attacks or dizziness.
Conclusions. CSD is a safe and simple technique to abolish either the cardioinhibitory or the vasodepressor response in CSS.
[J Neurosurg Sci 1998;42:189-93]
Key words: Carotid sinus - Denervation - Syncope etiology - Carotid sinus syndrome.
Carotid artery compression produces a mild fall in systemic blood pressure and a provisional slowing of cardiac rate; this is an important reflex in all normal persons.1
The two carotid sinuses are located at the bifurcation of each common carotid artery. The nerve fibres supplying the sinuses terminate in the sensory organs in the walls of the artery and carotid body and are derived from afferent fibers from both the vagus and glossopharyngeal nerves, with efferent connections from the superior cervical ganglion of the sympathetic trunk 2 (Fig. 1).
When digital stimulation of the carotid sinus results in marked slowing of cardiac rate or in cardiac asystole accompanied by a fall in systemic blood pressure is applied the term of "Hyperactive carotid sinus reflex",3 in this condition there aren't spontaneous symptoms and it has limited clinical significance. Presence of spontaneous symptoms in particular syncopal attacks or marked dizziness, is called "Carotid Sinus Syndrome".3
Three types of carotid sinus syndrome have been defined: 1) Cardioinhibitory: ventricular asystole occurring for longer than 3 seconds; 2) Vasodepressor: a decrease in systolic arterial blood pressure of more than 50 mmHg (with a less than 30% decrease in heart rate); 3) Mixed: a decrease in systolic blood pressure of more than 30 mmHg (with a more...