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Carotid endarterectomy using regional anesthesia: a benchmark for stenting
John M Stoneburner1, Garabed P Nishanian, Ramon A Cukingnan
1Cardiovascular Surgery Associates of the Southwest, Torrance, California 90503, USA.
The American Surgeon
|January 9, 2003
Summary
Regional block anesthesia for carotid endarterectomy allows continuous neurologic monitoring in awake patients. This method demonstrated a very low complication rate, making it a benchmark for future carotid stenting studies.
Area of Science:
- Vascular Surgery
- Anesthesiology
- Neurology
Background:
- Regional block (RB) anesthesia enables continuous neurologic monitoring during carotid surgery.
- This retrospective study evaluates RB for carotid endarterectomy (CEA).
Purpose of the Study:
- To assess the safety and efficacy of regional block anesthesia for carotid endarterectomy.
- To compare outcomes of RB anesthesia versus general anesthesia (GA) for CEA.
Main Methods:
- Retrospective analysis of 388 consecutive carotid endarterectomy procedures from 1995-2001.
- RB anesthesia was used in 314 cases, while general anesthesia was used in 74 cases.
- Patient outcomes including stroke, mortality, and need for shunting were analyzed.
Main Results:
- No new ipsilateral strokes occurred in the RB group; one patient had an extended stroke.
- Three in-hospital deaths occurred, all cardiac-related, in the RB group.
- The combined stroke and mortality rate for CEA-only patients was 1.3% (five of 372).
Conclusions:
- Regional block anesthesia is a safe and effective option for carotid endarterectomy, facilitating the procedure.
- CEA under RB allows awake patient monitoring, similar to carotid stenting.
- The low complication rate suggests RB should be a benchmark for future carotid angioplasty and stenting studies.