We investigated its efficacy, duration and safety to prevent perioperative bradycardia and hypotension caused by carotid sinus reaction (CSR) in carotid artery stenting (CAS).

Ultrasound-guided intermediate cervical plexus blockade has been used for regional anesthesia in carotid endarterectomy (CEA); however, it has only been applied for circulatory management in CAS in individual cases. 

We consecutively included patients co-morbid with cardiac diseases, who were tested to be poorly reactive to intravenous atropine. Overall, twenty patients underwent CAS were enrolled since 2022 in our center. Ultrasound-guided carotid sinus nerve block was conducted at the level of ipsilateral carotid bifurcation within 30 minutes before the procedure by injecting combined short-acting and long-acting local anesthetics (5ml lidocaine plus 5ml ropivacaine). Blood pressure and heart rate of each patient were continuously recorded during the perioperative period (within 24 hours). Associated complications such as cervical hematoma, were reported.

For efficacy, we did not observe any hemodynamic instability, specifically decrease of heart rate or blood pressure immediately after balloon angioplasty or stenting, requiring intravenous atropine rescue during CAS among all patients. During the procedure, we did not observe Three patients presented with delayed CSR, mainly hypotension, within 6 to 24 hours after the procedures.

For safety, no major complications associated with nerve block were observed, such as local anesthetic systemic toxicity, cervical hematoma and dysfunction of the un-targetted nerves. Though five cases with local pain and three with minor hemorrhage, which were skin bruise or small subcutaneous hematoma around injection sites, were considered as minor complications.

Carotid sinus nerve block may be considered as a safe and effective local anesthetic technique to prevent CSR during CAS. Future studies on investigating its efficacy and safety for patients on dual antiplatelets, and technical details, such as local anesthetic regimen to prolong acting duration and nerve block area, are warranted.