Carotid Endarterectomy Under Local Anesthesia: An Alternative Treatment for Carotid Stenosis

Purpose. Carotid artery stenosis accounts for approximately 10% of all ischemic strokes, causing significant morbidity and mortality. Historically the standard of care for surgical candidates for carotid stenosis was carotid endarterectomy, traditionally done under general anesthesia. As carotid stenting becomes an established less invasive modality of treatment, we investigated carotid endarterectomy under local anesthesia as an alternative option. Methods. We conducted a retrospective review of medical charts for patients undergoing carotid endarterectomy at a large community hospital from July 2007 to June 2010. 30-day postoperative myocardial infarctions and strokes were evaluated for patients undergoing carotid endarterectomy under local anesthesia, compared to carotid endarterectomy under general anesthesia. Carotid artery shunting and preoperative stroke were also evaluated as risk factors for postoperative myocardial infarction and stroke. Fisher exact tests were calculated to compare postoperative outcomes between patient groups. Results. A total of 407 carotid endarterectomies under local anesthesia and 256 carotid endarterectomies under general anesthesia were included in the analysis. Age, sex, and occurrence of preoperative stroke were similar between study groups. General anesthesia patients were more likely to receive a shunt (82% vs 11%, P\u3c.001). General anesthesia patients had higher rates of postoperative myocardial infarction (1.2% vs 0%, P=.057) and stroke (2.3% vs 0.7%, P=.095), but these differences were not statistically significant. Patients with a shunt also had non-significantly higher rate of postoperative stroke (2.3% vs 0.7%, P=.096). Conclusions. Our evidence suggests that carotid endarterectomy under local anesthesia can be an effective alternative for carotid stenosis with a possibly better safety profile than carotid endarterectomy under general anesthesia. Larger randomized studies are needed to further evaluate these complications