Local versus general anaesthesia for carotid endarterectomy--improving the gold standard ?

Abstract

Objective: Carotid endarterectomy (CEA) reduces stroke risk among selected patients. To achieve this, low operative risk is crucial. Outcome may depend on whether local (LA) or general (GA) anaesthesia is used. The aim of our study was to assess the risks of CEA under LA compared with that under GA. Primary endpoint was neurological outcome.

Design: Retrospective study, prospective data bank.

Patients and methods: Analysis was performed of hospital charts from 1341 consecutive patients undergoing carotid endarterectomy between January 1995 and December 2004. The patients were divided into two groups according to intraoperative anaesthesia (LA 465 patients or GA 876 patients).

Results: Cerebral complications (transient ischemic attacks and stroke combined) were more common in the GA group (6.9% vs. 3.4%, p<0.009, relative risk 0.48, 95% confidence interval (CI) 0.272-0.839). Mortality was 0.5% (LA) vs. 0.8% (GA). Combined death and stroke rate were not different between groups (4.1% vs. 3.2%). Postoperative hypertension episodes were more common in the LA group (47.7%, vs. GA 20.4%, p <0.001). Haematomas requiring surgery were more common in the GA group (6.4% vs. 3.0%, p<0.02).

Conclusion: CEA can be performed safely under LA. It may improve the results and lead to better neurological outcome as compared to GA. Risk factor analysis did not reveal specific risk groups.