Carotid endarterectomy: a comparison on general and local anesthesia

Objective.  Carotid endarterectomy (CEA) reduces disabling or fatal stroke risk in patients with significant carotid stenosis. The aim of this study was to compare the results of CEA performed under general anesthesia (GA) or local anesthesia (LA) in patients with symptomatic severe carotid artery stenosis.  Method.  We retrospectively collected the data on 64 patients who underwent CEA under GA (47 patients) and LA (17 patients) at our hospital from January 2010 to January 2014. All clinical, demographics, preoperative risk factors and postoperative data were compared for postoperative results. Surgical indications, techniques, and complications were also compared.  Results.  The groups were similar for age, gender and preoperative risk factors. There were no significant differences in death (GA: 4.2% vs. LA: 0%; p =1.0), stroke (GA: 4.2% vs. LA: 0%; p=1.0), death/ stroke rate (GA: 2.1% vs. LA: 0%; p=1.0), nerve injury (GA: 2.1% vs. LA: 5.8%; p=0.464), saphenous vein patch closure (GA: 83% vs. LA: 59%; p=0.051), shunt rate (GA: 8.5% vs. LA: 6 %; p=1.0), hospital stay (GA: 8.2±5.7 day vs. LA: 6.2±2.9 day, p=0.275), hematoma rate (GA: 0 %vs. LA: 5.8%; p =0.266) and transient ischemic attack rate (GA: 4.2% vs. LA: 0%; p=1.0) between the two techniques. Mortality occurred in two patients (both in the GA group) due to stroke and myocardial infarction. Conclusion. Carotid endarterectomy performed safely under general or local anesthesia is associated with low morbidity and mortality rates. Local anesthesia can be a safe option for evaluating the better neurological status during operation.