The authors did a prospective analysis of carotid baroreceptor reaction (BR) after stent placements in 95 patients with atherosclerotic carotid stenoses. The BR was specifically defined as periprocedural hypotension (systolic BP<90 mmHg), bradycardia (HR<50/min) or HR fluctuation (>20/min). Additionally, the BR was stratified into transient (<3hrs) and prolonged (3-24hrs). The results demonstrated different body responses in treatments of 2 different carotid bulb lesions: apex and body. The main significant information from the study is that the body lesion (which is proximal to the apical lesion) has more transient BR than the apical lesion, theoretically explainable by baroreceptor stimulation.

Nevertheless, there are some doubtful points in this article.

Table 1 and table 2 are a bit difficult to understand since the authors intended to differentiate between BR+ and BR- lesions, not between apical and body lesions. By counting overall numbers, the BR- case in transient table can be a case with BR+ in prolonged table and vise versa. There is no case overlapping between transient and prolonged BR+ (means no patient has hypotension within 3 hrs of treatment and during 3-24 hrs after treatment). Counting of the BR in this term is a spot event, not a mean value. There should be a high possibility to have this overlapped situation.

Finally, the authors tried to relate the difference between apical and body lesions with hyperperfusion syndrome which might be an overstatement. Actually, we don’t know the degree of stenosis between apical and body lesions in this study including the results of treatment in both groups (by table configuration provided in the article). The claim that there is a positive tendency of the adverse events and hyperperfusion in apical lesion could not be confirmed without showing balanced stenotic severity in between groups.