• Compression of the carotid artery in the neck was used as a test to predict whether a patient could tolerate a proposed ligation. Following such tests, ligations were carried out in 63 patients. Of these operations, 44 were for aneurysms, 10 for arteriovenous communications, and 9 for carotid cavernous fistulas. In some patients compression or even palpation of the carotid sufficed to cause bradycardia and syncope; if it was possible to abolish the bradycardia with atropine and if the completely atropinized patient withstood carotid compression for 10 minutes, it was assumed that he could undergo carotid ligation with a minimum of complications. If syncope was not prevented by atropine, and the pulse was not slowed on palpation, it was assumed that the cerebral ischemia was of mechanical rather than reflex origin and that the blood supply from the basilar artery and the contralateral carotid was not sufficient to permit the proposed ligation. Complications following the 63 ligations proved to be transient in all but two patients, who had intracranial aneurysms and had been very ill from the beginning. In applying the carotid compression test the electrocardiograph helped to identify vagal effects. The patency of the carotid and basilar arteries should be determined by angiography.
Gurdjian ES, Webster JE, Martin FA, Hardy WG. CAROTID COMPRESSION IN THE NECK—RESULTS AND SIGNIFICANCE IN CAROTID LIGATION. JAMA. 1957;163(12):1030–1036. doi:10.1001/jama.1957.02970470028007
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