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Improved results with carotid endarterectomy

J E Connolly, J H Kwaan, E A Stemmer

Annals of Surgery

|September 1, 1977

Summary

Carotid endarterectomy outcomes improved with local anesthesia and direct patient monitoring over general anesthesia with shunts. Stump pressure monitoring is unreliable for determining shunt necessity during carotid surgery.

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Area of Science:

Neurosurgery
Vascular Surgery
Anesthesiology

Background:

Carotid endarterectomy is a procedure to remove plaque from carotid arteries.
Intraoperative shunting is used to maintain cerebral perfusion during carotid clamping.
The decision to shunt is often based on stump pressure or neurological monitoring.

Purpose of the Study:

To compare outcomes of carotid endarterectomy performed under general anesthesia with shunting versus local anesthesia with intraoperative monitoring.
To evaluate the reliability of carotid stump pressure in determining the need for shunting.

Main Methods:

Retrospective review of 290 patients undergoing carotid endarterectomy.
Comparison of two groups: general anesthesia with shunt (1968-1972) and local anesthesia with stump pressure monitoring (1973-1975).
Analysis of perioperative complications, including death, hemiplegia, and transient limb weakness.

Main Results:

The general anesthesia group (n=188) had 3 deaths, 3 hemiplegias, and 2 transient weaknesses.
The local anesthesia group (n=102) had 1 death, 0 hemiplegias, and 0 weaknesses.
Carotid stump pressure was found to be an unreliable indicator for shunting, with some patients losing consciousness despite adequate pressures.

Conclusions:

Carotid endarterectomy under local anesthesia with direct patient monitoring offers improved outcomes compared to general anesthesia with shunting.
Intraoperative assessment of patient consciousness and motor ability is a more reliable criterion for shunting than stump pressure.
Avoiding shunts when not necessary can improve technical efficiency and reduce shunt-related complications.

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