Anesthetic management of carotid endarterectomy

Area of Science:

• Vascular Surgery
• Neurology
• Anesthesiology

Background:

• Carotid endarterectomy (CEA) is established for stroke risk reduction in symptomatic patients.
• Increasingly complex patients with carotid artery disease require optimized perioperative management.
• Carotid angioplasty and stenting (CAS) has emerged as a viable alternative, with evolving data on its efficacy and safety.

Purpose of the Study:

• To review recent developments in the anesthetic management of CEA.
• To evaluate the safety, efficacy, and durability of CAS.
• To compare CEA and CAS in the context of patient selection, comorbidities, and anesthetic techniques.

Main Methods:

• Review of selected literature from 2012 concerning anesthetic management for CEA.
• Analysis of recent studies on CAS, focusing on durability, comparative efficacy, and cost.
• Examination of patient selection, comorbidity management, risk prediction, and monitoring strategies.

Main Results:

• Anesthetic management for CEA and CAS requires careful consideration of patient comorbidities and hemodynamic goals.
• Various anesthetic techniques can be safely employed for patients with significant comorbidities undergoing CEA.
• Recent data indicate that CAS is not inferior to CEA in terms of durability and safety.

Conclusions:

• Perioperative management of comorbidities and continuous physiologic monitoring are crucial for successful CEA and CAS.
• Both CEA and CAS can be performed safely, with CAS demonstrating comparable long-term outcomes to CEA.
• The choice between CEA and CAS may depend on individual patient factors and evolving clinical evidence.