From the Research
Potential complications after carotid barostim placement include surgical site infection, hematoma formation, nerve injury, device migration, lead failure, pain at the implant site, hypotension, bradycardia, and rarely stroke or transient ischemic attack. Management of these complications varies based on severity and type.
- Surgical site infections typically require antibiotics (such as cephalexin 500mg four times daily for 7-10 days or clindamycin 300mg three times daily for patients with penicillin allergy) and possibly device removal in severe cases 1.
- Hematomas may resolve spontaneously but might require surgical evacuation if large or causing compression symptoms.
- Nerve injuries, particularly to the glossopharyngeal or hypoglossal nerves, may cause speech or swallowing difficulties and typically improve with time, though speech or swallowing therapy might be needed.
- Device-related issues like migration or lead failure require surgical revision.
- Pain at the implant site can be managed with analgesics like acetaminophen or short-term NSAIDs.
- Hemodynamic complications such as hypotension or bradycardia usually respond to device reprogramming with reduced stimulation parameters. Patients should be monitored closely during the first few weeks after implantation, with regular follow-up visits at 1 week, 1 month, and then every 3-6 months to assess device function and address any emerging complications, as supported by the study on the safety profile of baroreflex activation therapy 1. Immediate medical attention should be sought for severe pain, significant swelling, fever, altered mental status, or new neurological symptoms. The most recent and highest quality study on the safety profile of baroreflex activation therapy (NEO) in patients with resistant hypertension found that the device significantly lowers blood pressure and provides an adequate safety profile, with most adverse events being mild and resolving without sequel 1. Risk factors for complications, such as cranial nerve injury, include age ≥80 years, presence of a preoperative bleeding disorder, duration of operation, and need for reoperation, as identified in a study on risk factors for cranial nerve injury after carotid endarterectomy 2. Anesthesia management is also crucial during the implantation of baroreceptor stimulators, as certain anesthetic agents can dampen or inhibit the baroreceptor reflex, complicating the procedure 3. Overall, while complications can occur after carotid barostim placement, careful management and monitoring can minimize their impact and ensure the best possible outcomes for patients.