Korean J Thorac Cardiovasc Surg.  2019 Dec;52(6):392-399. 10.5090/kjtcs.2019.52.6.392.

Outcomes of Carotid Endarterectomy according to the Anesthetic Method: General versus Regional Anesthesia

• Kim JW
• Huh U
• Song S
• Sung SM
• Hong JM
• Cho A

• KMID: 2465825
• DOI: http://doi.org/10.5090/kjtcs.2019.52.6.392

Abstract

BACKGROUND
The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA).
METHODS
Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group.
RESULTS
There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period.
CONCLUSION
RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.

Keyword

Carotid arteries; Endarterectomy; Anesthesia; Shunts

MeSH Terms

Anesthesia
Anesthesia, Conduction*
Anesthesia, General
Carotid Arteries
Cervical Plexus Block
Endarterectomy
Endarterectomy, Carotid*
Follow-Up Studies
Humans
Length of Stay
Medical Records
Methods*
Mortality
Myocardial Infarction
Operative Time
Prospective Studies
Retrospective Studies
Stroke