Carotid Endarterectomy

Abstract

Carotid artery stenosis is associated with an elevated incidence of stroke, and carotid endarterectomy is performed to prevent future strokes in cases of severe carotid artery stenosis. Patients presenting for carotid endarterectomy often have a number of comorbidities that make them challenging to anesthetize. Both regional and general anesthetic techniques may be successfully used, but with either, careful management of hemodynamics throughout the perioperative course is critical. During carotid cross-clamping, it is important to monitor the patient’s neurologic status to ensure adequate perfusion to the ipsilateral hemisphere, and for this, a number of neuromonitoring modalities are available, with EEG monitoring being the most common. Several potential complications require close monitoring of the patient in the immediate postoperative period. This review contains 6 figures, 7 tables, and 49 references. Key Words: carotid artery stenosis, carotid endarterectomy, carotid artery stenting, cerebral hyperperfusion syndrome, cervical plexus block, electroencephalography, neck hematoma, neuromonitoring, preoperative optimization, stroke, transcranial Doppler