Carotid endarterectomy: technical practices of surgeons participating in the GALA trial

Abstract

Objective: Recent meta-analyses confirm an advantage to patch angioplasty during carotid endarterectomy (CEA) and suggest a benefit from routine shunting. GALA Trial (RCT: general [GA] versus local [LA] anaesthesia for CEA) collaborators (non-UK [European] and UK) were surveyed to assess current practice techniques.

Materials and methods: Postal questionnaires determined: shunt usage, monitoring techniques dictating shunt deployment, criteria for patching and the influence of anaesthetic technique upon these decisions.

Results: 157/216 surgeons (73%) replied. For UK surgeons (n=76) performing GA CEA a shunt was always, never, or selectively used by 73.6%, 4.2% and 22.2% respectively. Figures for non-UK surgeons (n=77) were 20.8% (p<0.0001), 26% (p<0.0002) and 53.2% (p<0.0001). When shunting selectively, fewer UK surgeons relied on stump pressure (26.4% v 48.1%; p<0.0064) with TCD more widely used (38.9% v 11.7%; p<0.0001). Shunting criteria during LA CEA were the same for both groups (impaired awake-testing). Routine patching was commoner amongst UK surgeons (GA: 76.4% v 34.2%, p<0.0001; LA: 70.1% v 31.9%, p<0.0001).

Conclusions: These results indicate that more UK surgeons have adopted current suggestions for improving CEA outcomes. Future analysis of unblinded GALA Trial data may provide further information about the impact of different policies for shunting and patching.