Related Experiment Video
Updated: Apr 7, 2026
A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application
Published on: July 9, 2020
Examination of regional anesthesia for carotid endarterectomy
Laura Pasin1, Pasquale Nardelli1, Giovanni Landoni2
1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Insights
Carotid endarterectomy under regional anesthesia is safe, with a very low conversion rate to general anesthesia. This study found it effective for reducing stroke risk in patients with significant carotid stenosis.
Area of Science:
- Anesthesiology
- Neurosurgery
- Vascular Surgery
Background:
- Carotid endarterectomy is a key procedure for preventing stroke in patients with significant carotid stenosis.
- Regional anesthesia is an alternative to general anesthesia, but its failure rate requires further investigation.
Purpose of the Study:
- To evaluate the incidence of intraoperative conversion from regional to general anesthesia during carotid endarterectomy.
- To assess the safety and efficacy of regional anesthesia for this procedure.
Main Methods:
- A retrospective analysis of 2463 carotid endarterectomies performed between June 2009 and December 2014.
- Regional anesthesia (deep/superficial cervical plexus block) was the primary anesthetic technique, with general anesthesia reserved for contraindications.
- Intraoperative remifentanil infusion was used to ensure patient comfort and cooperation.
Main Results:
- Regional anesthesia was initially used in 2439 patients, with only 7 conversions to general anesthesia (0.29% incidence).
- Intraoperative complications included acute neurologic deterioration requiring repeat surgery (0.53%), myocardial infarction (0.04%), and tachyarrhythmia (0.04%).
- The combined stroke and death rate was low at 1.62% (40 patients).
Conclusions:
- Carotid endarterectomy under regional anesthesia is a safe and effective option.
- The rate of conversion to general anesthesia is very low in experienced hands.
- Regional anesthesia is associated with favorable perioperative outcomes for carotid endarterectomy.
Objective:
Carotid endarterectomy is the most effective treatment for reducing the risk of stroke in patients with significant carotid stenosis. Few studies have focused on the failure rate of regional anesthesia.
Methods:
Data of all patients undergoing carotid endarterectomy (June 2009 to December 2014) in a single center were collected. Combined deep and superficial cervical plexus block or superficial plexus block alone was used according to the attending anesthesiologist's choice and the patient's characteristics (eg, dual antiplatelet or anticoagulation therapy). Intraoperative remifentanil (0.025-0.05 μg/kg/min) was administered to maintain an adequate level of comfort, responsiveness, and cooperation. General anesthesia was planned only in the case of major contraindications or the patient's refusal of locoregional anesthesia. The primary end point of our study was the incidence of intraoperative conversion from locoregional to general anesthesia.
Results:
A total of 2463 carotid endarterectomies were included in the analysis. Regional anesthesia was initially chosen in 2439 patients, whereas 24 patients received planned general anesthesia. In seven cases, regional anesthesia was converted to general anesthesia because of severe agitation of the patient (before clamping in four cases, after carotid clamping in two cases, and after declamping in one case). A shunt was used in 302 patients (12.3%) because of neurologic deterioration at the carotid clamping test. Intraoperative complications were emergent repeated surgical procedures in 13 cases (0.53%) because of acute neurologic deterioration, 1 intraoperative acute myocardial infarction (0.04%), and 3 cases (0.04%) of hemodynamically relevant supraventricular tachyarrhythmia. No intraoperative death occurred. In-hospital mortality was 0.12% (three patients). Major stroke occurred in 23 patients (0.93%); minor stroke occurred in 16 patients (0.65%). The combined stroke and death rate was 1.62% (40 patients).
Conclusions:
In our practice, carotid endarterectomy under regional anesthesia is safe and associated with a very low rate of conversion to general anesthesia.
More Related Videos
13:50Focal Cerebral Ischemia Model by Endovascular Suture Occlusion of the Middle Cerebral Artery in the Rat
Published on: February 5, 2011
09:11Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability
Published on: February 23, 2016
Related Concept Videos
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
One of the advantages of...
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:22Aneurysm IV: Nursing Management
01:12Regional Terms
Primarily, the human body has two major regions, the axial and appendicular regions. The axial region comprises regions from the head to the abdomen and makes up the central body axis. In contrast,...
01:30Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia