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Review
. 2021 Apr 19:65:102327.
doi: 10.1016/j.amsu.2021.102327. eCollection 2021 May.

Plexus anesthesia versus general anesthesia for carotid endarterectomy: A systematic review with meta-analyses

M S Marsman  1 , J Wetterslev  2 , F Keus  3 , D van Aalst  4 , F G van Rooij  5 , J M M Heyligers  6 , F L Moll  7 , A Kh Jahrome  8 , P W H E Vriens  6 , G G Koning  9
Affiliations
Review

Plexus anesthesia versus general anesthesia for carotid endarterectomy: A systematic review with meta-analyses

M S Marsman et al. Ann Med Surg (Lond). .

Abstract

Introduction: Traditional carotid endarterectomy is considered to be the standard technique for prevention of a new stroke in patients with a symptomatic carotid stenosis. Use of plexus anesthesia or general anesthesia in traditional carotid endarterectomy is, to date, not unequivocally proven to be superior to one other. A systematic review was needed for evaluation of benefits and harms to determine which technique, plexus anesthesia or general anesthesia is more effective for traditional carotid endarterectomy in patients with symptomatic carotid stenosis.

Methods: The review was conducted according to our protocol following the recommendations of Cochrane and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were updated on the October 1, 2020. We did not find any randomized clinical trial comparing plexus anesthesia and general anesthesia in carotid endarterectomy with patch angioplasty matching our protocol criteria in patients with a symptomatic and significant (≥50%) carotid stenosis.

Conclusions: Based on the current, high risk of bias evidence, we concluded there is a need for new randomized clinical trials with overall low risk of bias comparing plexus anesthesia with general anesthesia in carotid endarterectomy with patch closure of the arterial wall in patients with a symptomatic and significant (≥50%) stenosis of the internal carotid artery.Protocol unique identification number (UIN): CRD42019139913, (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139913).

Keywords: Carotid endarterectomy; General; Local anesthesia; Plexus; Stenosis; Systematic review.

PubMed Disclaimer

Conflict of interest statement

JW is a member of the taskforce at Copenhagen Trial Unit to develop theory and software doing TSA, presently available as freeware at www.ctu.dk/tsa.

Figures

Fig. 1
Fig. 1
Closure of carotid artery. CCA: common carotid artery, STA: superior thyroid artery, ECA: external carotid artery, ICA: internal carotid artery. A: Longitudinal arteriotomy B: Closure of longitudinal arteriotomy with patch angioplasty.
Fig. 2
Fig. 2
Hierarchy of outcomes from patients' perspective undergoing carotid endarterectomy for symptomatic carotid stenosis (GRADE 2008). * At maximum follow up. Other serious adverse events includes stroke <30 days.
Fig. 3
Fig. 3
Flow diagram summarizing the search process and results of each phase of the systematic review. https://doi.org/10.1371/journal.pmed1000097.
See this image and copyright information in PMC

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