Anesthesia for Carotid Stent Procedures

Abstract

Purpose: To present the techniques of anesthesia management used during percutaneous carotid interventions involving balloon dilation and stent deployment. Methods and Results: Two access routes may be used for carotid angioplasty, and the anesthesia techniques for each are different. In the conventional common femoral artery approach, the patient is sedated, heparinized, and ventilated by mask with 100% oxygen; the groin site is anesthetized locally with lidocaine. When the procedure reaches the point of balloon inflation, the patient is awakened, and atropine is administered to block the baroreceptor response. The heparin is not reversed after the procedure. General anesthesia with short-acting nonopioid intravenous anesthetics is preferred for patients undergoing direct puncture of the common carotid artery. The patient is intubated and ventilated with 100% oxygen. Here the patient is awakened after completion of the procedure, at which time protamine sulfate is used if needed to restore coagulation time to normal prior to sheath removal. The anesthesiologist must be vigilant in monitoring hemodynamic and neurological status throughout these carotid interventions, particularly during balloon inflations and after the sheath removal for the cervical approach. Conclusions: Anesthesia for percutaneous carotid interventions differs from that used for carotid surgery. Protection of the brain from ischemic insult is paramount, and scrupulous attention to physiological factors influencing cerebral blood flow is mandatory. The anesthesiologist plays a crucial role in maintaining hemodynamic stability, adjusting anticoagulation, and monitoring neurological status.