Chapter 21 - Anesthesia for carotid endarterectomy

Abstract

Carotid endarterectomy (CEA) is a recommended surgical treatment modality for primary and secondary stroke prevention in patients with asymptomatic and symptomatic carotid artery stenosis (CAS). The clinical benefits of carotid revascularization are directly associated to the degree of carotid artery luminal stenosis. The current literature provides conclusive evidence-based guidelines suggesting the timing as well as indications for CEA. However, the same is still lacking with regards to the choice between general anesthesia (GA) and local/regional anesthesia (LA/RA) during CEA. To date, several large randomized and non-randomized studies have compared GA with LA/RA with contradictory results. Overall, the current evidence has not been able to determine the most favorable anesthetic modality for CEA, leaving the choice predominantly to surgeons and anesthetist’s preferences and patients’ needs and morbidities. In this chapter, we shall describe the evidence-based information available to date and the ongoing trials in the pursuit of determining the optimal anesthetic technique for CEA.