Impact of Conversion from Local/Regional to General Anesthesia on Outcomes in Transcarotid Artery Revascularization

This study evaluates impact of converting from local to general anesthesia on transcarotid artery revascularization (TCAR) outcomes and identifies risk factors predictive of conversions.

A total of 58,960 TCAR cases from the Vascular Quality Initiative (2018-2024) were categorized by anesthesia type: 6,831 local/regional anesthesia (LRA), 51,851 general anesthesia (GA), and 278 conversions from LRA to GA. In-hospital outcomes were compared using multivariate logistic regression, with stroke/death as the primary endpoint. Preoperative predictors of conversion were also assessed.

Converted patients were oldest, more often obese, and more likely to undergo urgent procedures. Compared to LRA, conversion was associated with increased odds of in-hospital stroke/death (adjusted odds ratio [aOR] = 3.01; 95% confidence interval [CI], 1.54-5.36; P < 0.001), stroke/death/MI (aOR = 2.92; 95% CI, 1.58-5.00; P < 0.001), and prolonged hospital stay (aOR = 1.38; 95% CI, 1.05-1.80; P = 0.020). Compared to GA, converted patients had higher odds of stroke/death (aOR = 2.95; 95% CI, 1.55-5.09; P < 0.001) and stroke/death/MI (aOR = 2.75; 95% CI, 1.52-4.57; P < 0.001). Compared to LRA, GA was only associated with longer hospital stay. Age and urgent procedures were significant preoperative predictors of conversion to GA (P < 0.05).

Conversion from LRA to GA during TCAR is associated with higher rates of stroke, death, and MI compared to LRA or initial GA. Age and urgent TCAR procedures were identified as critical preoperative factors influencing conversion risk. These findings underscore the importance of meticulous preoperative risk assessment and optimal anesthesia selection to minimize conversions and enhance safety in TCAR.