carotid sinus stimulation
The safety end-point included the major adverse neurological or cardiovascular system or procedure-related event rate (MANCE). They noted that larger randomized, controlled trials are ongoing to verify chronic benefits. In severe cases of Carotid Sinus Hypersensitivity or Carotid Sinus Syndrome, there is loss of consciousness or seizures that may occur due to buildup of pressure in the carotid sinus arteries as a result of manual stimulation. Despite the availability of potent anti-hypertensive medications, many patients remain hypertensive. list-style-type : square !important; During control conditions, carotid sinus stimulation induced a significant decrease in arterial pressure and heart rate. At least three-second asystole (cardio-inhibition - the most common form; 70-75% of cases). There were no adverse events attributable to the device. These investigators drew attention to deficiencies in the database. Furthermore, these researchers tested whether ES impairs the physiological baroreflex regulation. text-decoration: underline; Vasc Surg. A slight dilation of the common carotid artery at its bifurcation into external and internal carotids; it contains baroreceptors, which, when stimulated, cause slowing of the heart, vasodilation, and a fall in blood pressure; is innervated primarily by the glossopharyngeal nerve. Heusser and colleagues (2016) stated that bilateral bipolar electric carotid sinus stimulation acutely reduced muscle sympathetic nerve activity (MSNA) and BP in patients with resistant arterial hypertension; but is no longer available. The authors concluded that a surgically implantable device for ES of the carotid baroreflex system can be placed safely and produces a significant acute decrease in BP without significant side effects. The authors stated that this study had several drawbacks. Europace. It results in dizziness or syncope from transient diminished cerebral perfusion. Electrical stimulation of the carotid sinus baroreflex system has been shown to produce significant chronic blood pressure decreases in animals. central iliac arterio-venous anastomosis. For catheter-based renal denervation, few large-animal data are available to investigate the effect of the intervention on the histology of the arterial wall. In the past years, device- and implant-mediated therapies have evolved and extensively studied in various patient populations. The authors concluded that a clinically meaningful measure, those achieving a SBP of less than or equal to 140 mm Hg, yielded a significant difference between the groups. or more (vasodepression). } 2011;57(5):880-886. /* aetna.com standards styles for templates */ The phase II Rheos Feasibility Trial was performed to assess the response of patients with multidrug-resistant hypertension to such stimulation. Moreover, these researchers noted that BeAT-HF was not a blinded trial; the control group did not have an implanted BAT device. Kidney Int. The purpose of this paper is to overview the argument starting from physiological background and evaluating the clinical results obtained with this approach in these pathophysiological conditions. carotid sinus a dilatation of the proximal portion of the internal carotid or distal portion of the common carotid artery, containing in its wall pressoreceptors that are stimulated by changes in blood pressure. Or Sign up/login to Reverso account Kollaboratives Wörterbuch Englisch-Französisch. Copyright Aetna Inc. All rights reserved. It’s easy and only takes a few seconds. Portable, wearable, or wireless devices for magnetic brain stimulation are under‐developing. An external programmer was used to optimize and individualize efficacy. However, in the skeletal muscle, represented by a forearm segment, vascular resistance decreased significantly. In this randomized, sham-controlled pilot study, we evaluated the effects of MSCS on blood pressure in pre-hypertensive and hypertensive subjects. It results in dizziness or syncope from transient diminished cerebral perfusion. Prior to implant, BP was 189.6 +/- 27.5 (SBP)/110.7 +/- 15.3 (diastolic BP [DBP]) mm Hg despite stable therapy (5.2 +/- 1.8 anti-hypertensive drugs). The enthusiasm for this modality has led to ongoing studies, which will provide more information on its safety and effectiveness in patients with drug-resistant hypertension. The Rheos Baroreflex Hypertension Therapy System (CVRx, Inc., Minneapolis, MN) is an implantable device for the treatment of patients with drug-resistant hypertension (i.e., the hypertensive state characterized by the inability of multiple anti-hypertensive drug interventions to lower BP to goal levels) who have a systolic BP (SBP) of greater than or equal to 160 mm Hg. list-style-type: decimal; Baroreflexes are one of many control systems acting in concert. Victor (2015) noted that arterial baroreceptors are mechano-sensitive sensory nerve endings in the walls of the carotid sinuses and aortic arch that buffer the increases and decreases in arterial BP. However, it did not meet the endpoints for acute responders or procedural safety. 2010;24(2):178-184. Acute electrical field stimulation of even 1 carotid sinus can cause a sufficiently large reflex decrease in BP to overcome off-setting reflexes from the contralateral carotid baroreceptors and aortic baroreceptors that are not paced. 2011;19(2):52-75. These short-term data support the concept of CSL placement and merit long-term investigation in a larger multi-center prospective trial. By observing and recording how the blood pressure of a patient and other symptoms change during stimulation, doctors can determine the seriousness of the condition. Eur J Vasc Endovasc Surg. The authors noted that the Barostim Hypertension Pivotal Trial (clinicaltrials.gov: NCT01679132) is currently in progress and aims to enroll 310 patients with RHTN randomized to receiving optimal medical management alone or in combination with the BAT, which may also have a role outside of BP management and is currently being evaluated as an adjunctive therapy in HF. This post-market phase will be achieved when 320 mortal and morbid events have occurred. Colucci WS. Baroreflex activation therapy (BAT) produced by stimulating the carotid sinuses using the Rheos device is being studied for the treatment of hypertension, the primary co-morbidity of HFpEF. Wallbach and associates (2016) noted that BAT has been demonstrated to decrease office BP in the randomized, double-blind Rheos trial. 2010;8(11):1579-1585. Carotid sinus syndrome can be diagnosed with carotid sinus massage. Baroreflex activation therapy in patients with heart failure with reduced ejection fraction. They studied 7 men and 5 women (aged 43 to 69 years) with drug-resistant arterial hypertension. They stated that future clinical trials will address the limitations of this study and further define the therapeutic benefit of BAT. The blood pressure decrease mainly reflected a reduction in cardiac output, total peripheral vascular resistance being essentially unchanged. 2009;2009:4626-4630. Three minor procedure-related complications occurred within 30 days of implant. The authors concluded that BAT was safe and significantly improved QOL, exercise capacity, and NT-proBNP. Heusser et al (2010) tested the hypothesis that ES of carotid baroreceptors acutely reduces sympathetic vasomotor tone and BP in patients with drug-resistant arterial hypertension. Georgakopoulos et al (2011) stated that heart failure with preserved ejection fraction (HFpEF) is a substantial public health issue, equal in magnitude to heart failure with reduced ejection fraction. J Hypertens. A carotid massage, often called a carotid sinus massage or CSM, is a medical maneuver used to slow down a dangerously rapid heartbeat in patients or to diagnose certain heart rhythm disturbances. Enrollment will continue as initially planned until a total of 480 patients have been randomized. 4. Measurements were performed under resting conditions, with and without electric baroreflex stimulation, for greater than or equal to 6 minutes during the same experiment. Novel baroreflex activation therapy in resistant hypertension: Results of a European multi-center feasibility study. Electrical stimulation (ES) of the carotid sinus has been shown to lowers blood pressure (BP) by activating the baroreflex and thereby reducing sympathetic tone. Translations in context of "carotid sinus stimulation" in English-French from Reverso Context: A total of 30 patients enrolled from 7 medical centers in Europe and Canada. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Curr Hypertens Rep. 2015;17(9):587. The use of vagal stimulation to halt supraventricular tachycardia is a standard medical therapy. Bisognano JD, Bakris G, Nadim MK, et al. Zhang J, Zhou S, Xu G. Carotid baroreceptor stimulation: A potential solution for resistant hypertension. Thus, non-pharmacological therapies have been attracting more interest. Georgakopoulos D, Little WC, Abraham WT, et al. Lohmeier and Iliescu (2011) summarized the pre-clinical studies that have provided insight into the mechanisms that account for the chronic BP-lowering effects of carotid baroreflex activation. width: 100%; Acute stimulation with intensities producing side effects that were tolerable in the short-term elicited inter-individually variable changes in systolic BP (-16.9 ± 15.0 mmâHg; range of 0.0 to -40.8 mmâHg; p = 0.002), HR (-3.6 ± 3.6 bpm; p = 0.004), and MSNA (-2.0 ± 5.8 bursts/min; p = 0.375). Indeed, baroreflex mechanisms contribute to long-term BP control by governing efferent sympathetic and parasympathetic activity. Remarkably, carotid sinus stimulation selectively improved endothelium-dependent acetylcholine-induced vasodilation ex vivo while endothelial nitric oxide synthase protein expression or phosphorylation did not change. They stated that although feasibility studies have been promising, firm conclusions regarding the value of this device-based therapy for the treatment of drug-resistant hypertension awaits the results of current multi-center trials. This result was sustained in 17 subjects who completed 2 years of follow-up, with a mean reduction of 33/22 mm Hg. Following these encouraging results, human trials to evaluate the clinical application of electrical carotid sinus manipulation in the treatment of systemic hypertension have commenced, and results so far indicated that this represents an exciting potential tool in the clinician's armament against chronic arterial hypertension. The arterial baroreflex regulates mean arterial pressure by responding automatically to changes in cardiac output and vessel tone via baroreceptors, which monitor arterial pressure by gauging the degree of stretch in vessel walls. Vienna, Austria; Ludwig Boltzmann Institute for Health Technology Assessment; 2018. Last Review 03/02/2021. Carotid sinus hypersensitivity is diagnosed when carotid sinus massage causes a three second, or longer, pause in the heart beat (cardioinhibition) – see ECG traces below – or lowering of the blood pressure by 50 mm Hg. Gierthmuehlen and colleagues (2020) presented an overview on recent developments in permanent implant-based therapy of resistant hypertension. Hoppe UC, Brandt MC, Wachter R, et al. https://medical-dictionary.thefreedictionary.com/Carotid+sinus+stimulation. Activation of baroreceptors produces immediate responses in cardiovascular sympathetic and cardiac parasympathetic nerves to adjust heart rate (HR), stroke volume, vasoconstriction, as well as fluid excretion. carotid sinus stimulation does not change ex vivo vascular reactivity to the alpha-adrenoreceptor agonist phenylephrine. It decreases the sympathetic activity and inhibits the renin system, which results in reduced blood pressure and heart rate. Additional comments: To ensure the quality of comments, you need to be connected. The mean procedure time was 202 +/- 43 minutes. .fixedHeaderWrap { Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Carotid sinus nerve (CSN) denervation has been shown to improve glucose homeostasis in insulin-resistant and glucose-intolerant rats; however, these positive effects from surgery appear to diminish over time and are heavily caveated by the severe adverse effects associated with permanent loss of chemosensory function. The authors concluded that acute activation of either treatment seems to reduce sympathetic tone dramatically; however, whether or not the effects are sustained over time is unknown. Overview of the management of heart failure with reduced ejection fraction in adults. Curr Hypertens Rep. 2016;18(8):61. 2012;172(1-2):31-36. Smaller coils of 50 mm diameters have been used in rats for research. In a subset (n = 6) of patients with prior renal nerve ablation, arterial BP decreased by 22.3 +/- 9.8 mm Hg. Effectiveness end-points were the change from baseline to 6 months in 6-min hall walk distance (6MHW), Minnesota Living with HF Questionnaire quality-of-life (QOL) score, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Jordan et al (2012) noted that recently, a novel implantable device was developed that produces an electrical field stimulation of the carotid sinus wall. Ng MM, Sica DA, Frishman WH. Sanchez et al (2010) evaluated carotid artery structural integrity after implantation of the CSLs. Others have been surprising and controversial, and resolution will require further investigation. The 5 co-primary endpoints were. However, side effects may limit efficacy. Scheffers IJ, Kroon AA, Schmidli J, et al. In addition, the CSN stimulation also reduced the gingival and plasma pro-inflammatory cytokines induced by periodontitis. Tordoir et al (2007) examined peri-operative outcomes and BP responses to an implantable carotid sinus baroreflex activating system being investigated for the treatment of drug-resistant hypertension. 2016;67(4):701-709. Heusser K, Tank J, Brinkmann J, et al. Internal Carotid Artery, Percutaneous Endoscopic Approach 39.82 Implantation or replacement of carotid sinus stimulation lead(s) only 03HK0MZ . This latter peculiarity has implemented the research for new approaches to the treatment of the disease. In a phase II clinical trial, Illig et al (2006) evaluated the response of patients with multidrug-resistant hypertension to ES of the carotid sinus via an implantable device. The first-generation device applies bilateral stimulation through bipolar electrodes placed around the carotid sinuses. The most invasive approach for resistant hypertension still is the neuromodulation by deep brain stimulation (DBS), which has been shown to significantly lower BP in single cases. Joshi and associates (2009) stated that ES of the carotid sinus baroreceptor through a surgically implanted device is currently under clinical investigation and is showing some encouraging early results. J Vasc Surg. Due to their invasiveness, such therapeutic options must prove superiority over conventional therapies with regard to safety and efficacy before they could be generally offered to a wider patient population. Carefully conducted experiments in dogs provided important insight in mechanisms mediating the depressor response to electrical carotid sinus stimulation. Bisognano et al (2011) examined the effect of baroreflex activation therapy (BAT) on SBP in patients with resistant hypertension. The electrical stimulation of carotid baroreceptors is a noninvasive procedure achieved by: An implantable bilateral carotid stimulator (electrodes) permanently placed in the perivascular space around the sinus of the carotid arteries; A pulse generator (battery-operated) subcutaneously implanted in the infraclavicular space; Hemodynamic responses to magnetic stimulation of carotid sinus in normotensive rabbits. Ontheotherhand, pressure applied below the carotid sinus, by occluding thecarotid artery, causes hypotension in the sinus, and produces reflexly tachycardia and peri-pheral vasoconstriction. Despite an initial drawback in a RCT of bilateral carotid sinus stimulation (CSS), new and less invasive and unilateral systems for BAT with the BAROSTIM NEO have been developed which show promising results in small non-RCTs. Zhang and colleagues (2017) evaluated the effectiveness of magnetic stimulation of carotid sinus (MSCS), a non-invasive strategy, for lowering BP in rabbits; MSCS with graded intensities and frequencies were systematically attempted in normotensive rabbits; BP was recorded dynamically.