The General Anesthesia vs. Local Anesthesia for Caro-

tid Surgery (GALA) trial did not show a difference in 30-day postoperative stroke, myocardial infarction and death rates between patients undergoing carotid endar-terectomy (CEA) under local vs. general anesthesia. The present article discusses some limitations of the GALA trial. Firstly, the expected stroke and death rates following CEA is so low, that it was unlikely that the GALA trial would show any significant difference between local and general anesthesia. Secondly, pre-operative statin use was not recorded. Thirdly, intra-operative shunt usa ge rates (a possible parameter for the development of stroke) varied considerably between the 2 groups (43 % vs. 14%, for general vs. local anesthe-sia, respectively; P <.0001), as well as between UK and non-UK surgeons who always (73.6 % vs. 20.8%, res-pectively; P <.0001), never (4.2 % vs. 26%, respectively; P <.0002), or selectively (22.2 % vs. 53.2%, respec-tively; P <.0001) used a shunt. Furthermore, no infor-mation was provided regarding the type of shunts used; for example, atraumatic shunts may be associated with lower perioperative stroke rates. These limitations could influence the interpretation of the results of the GALA trial. Due to lack of differences between the 2 groups and the presence of the above limitations, it seems likely that this trial will have little effect on clin-ical practice