Carotid endarterectomy: regional versus general anesthesia

Area of Science:

• Vascular Surgery
• Neurology
• Anesthesiology

Background:

• Carotid endarterectomy is a procedure to remove plaque from carotid arteries.
• Anesthesia choice and shunt use can impact patient outcomes.

Purpose of the Study:

• To compare the outcomes of carotid endarterectomy performed with regional anesthesia versus general anesthesia with routine shunt use.
• To evaluate the impact of anesthesia technique on perioperative mortality and neurologic complications.

Main Methods:

• Retrospective review of 421 patients undergoing carotid endarterectomy.
• Comparison of outcomes between two groups: regional anesthesia (1967-1972) and general anesthesia with routine shunt (1974-1976).
• Data collected included 30-day mortality and incidence of fixed and transient neurologic deficits.

Main Results:

• Regional anesthesia group: 10% required general anesthesia/shunt; 30-day mortality 2.6%; fixed deficits 2.2%; transient deficits 3%.
• General anesthesia group: 30-day mortality 0.5%; fixed deficits 2.6%; transient deficits 2.6%.
• No significant difference in mortality or neurologic complications between the two anesthesia techniques.

Conclusions:

• General anesthesia with routine shunt use did not significantly improve outcomes compared to regional anesthesia for carotid endarterectomy.
• Patients with postoperative strokes had multiple stenotic or occlusive lesions, indicating a high-risk group requiring special precautions.