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Carotid endarterectomy under local anaesthesia does not increase plasma homocysteine concentration
A Assadian1, U Eidher, C Senekowitsch
1Department of General and Vascular Surgery, Wilhelminenspital Vienna, Vienna, Austria. afshin_assadian@yahoo.de
Insights
Carotid endarterectomy under regional anesthesia does not increase homocysteine (Hcy) levels. This study found no significant Hcy changes in patients undergoing this procedure for internal carotid artery stenosis.
Area of Science:
- Vascular Surgery
- Anesthesiology
- Biochemistry
Background:
- Elevated homocysteine (Hcy) is a risk factor for cardiovascular disease.
- Carotid endarterectomy is a procedure to remove plaque from carotid arteries.
- The impact of anesthesia type on Hcy levels during carotid surgery is not fully understood.
Purpose of the Study:
- To evaluate the effect of carotid endarterectomy under regional anesthesia on homocysteine concentrations.
- To compare Hcy changes with findings from general anesthesia procedures.
Main Methods:
- A cohort study of 91 patients with >70% internal carotid artery stenosis.
- All patients underwent eversion endarterectomy under regional anesthesia.
- Homocysteine levels were measured preoperatively, on day 5, and at 6 months postoperatively.
Main Results:
- No significant changes in mean homocysteine levels were observed during the 6-month follow-up.
- Preoperative Hcy levels were 13.9+/-4.8 micromol/l, with no significant increase postoperatively.
- No intraoperative or 6-month follow-up strokes, TIAs, or deaths occurred.
Conclusions:
- Carotid endarterectomy performed under regional anesthesia does not lead to increased postoperative homocysteine levels.
- This contrasts with findings in cardiac surgery and animal studies using general anesthesia.
- Regional anesthesia appears safe regarding homocysteine metabolism during carotid endarterectomy.
Introduction:
The purpose of this cohort study was to evaluate the effect of carotid endarterectomy under local anaesthesia on homocysteine (Hcy) concentrations.
Patients And Methods:
Of 100 patients with internal carotid artery (ICA) stenosis >70%, the complete data set was available for 91 patients (39 asymptomatic and 52 symptomatic). All patients underwent eversion endarterectomy of the ICA under regional anaesthesia.
Results:
Thirty-two percent of the examined patients had a total Hcy above 15 micromol/l. The mean Hcy levels preoperatively were 13.9+/-4.8 micromol/l. The Hcy levels on day 5 were 13.1+/-5.0 micromol/l and after 6 months 14.0+/-5.8 micromol/l. There was no significant change during follow-up. No intraoperative strokes and deaths were observed and during the 6 months follow-up no recurrent strokes, TIAs or deaths occurred.
Conclusion:
Patients undergoing carotid endarterectomy under regional anaesthesia do not have an increase in total Hcy postoperatively. This finding is in contrast to results from cardiac surgery and carotid endarterectomy in a recently published animal study, both performing surgery under general anaesthesia.
