General vs Local Anesthesia and Completion Angiography Findings After Carotid Endarterectomy

Abstract

Introduction: To assess the differences of completion angiography after carotid endarterectomy between local and general anesthetic approach. Our secondary outcomes were to evaluate the relationship between intraoperative reparations and postoperative strokes; and to assess the usefulness of external carotid reparation when it was occluded during the procedure. Methods: A prospective study from January 2003 to January 2019 was performed including 1470 consecutive patients having 1559 carotid endarterectomies. Exclusion criteria were patients with allergy to contrast media. In our cohort, the surgical technique performed was carotid endarterectomy with patch in 96,95% of cases and carotid eversion in 3,05% of patients. 42,8% of them were asymptomatic, 11,4% had a stroke and 45,8% had a transient ischemic attack. Angiography was performed on 1289 cases. Findings included stenosis of common, external or internal carotid artery, occlusion of external carotid artery and intimal flap or intraluminal filling defect on internal carotid artery. The decision to repair the defect was based on the consensus of the surgical team. Intrahospitalary stroke rate was recorded. Categorical data were analyzed by the chi-square test and continuous data were expressed as mean standard deviation, median and interquartile range. Results: Comparing both anesthetic groups, we found more angiographic defects on the general anesthetic group (236 patients (22%)) than in the local anesthetic group (35 patients (13,7%))(p = 0.001) and more shunt need (42,2% vs 23,3% p = 0,001) but it did not result in more stroke rates (2,8% vs 1,9% p = 0.57). Of those 271 defects, 174 affected the common or internal carotid artery, and 45 were suitable for reparation (26% in general anesthesia group vs 25% in local anesthesia group (p = 0.9)). Postoperative strokes were similar among patients who underwent reparation or not (0% vs 3,9% p = 0.18). We found 64 external carotid occlusions. 37 of them underwent reparation, without differences among postoperative stroke rates (3,6% vs 2,8% p = 0.85). Conclusion: Patients under general anesthesia for carotid endarterectomy have more postoperative angiographic defects, but its reparation does not seem to affect postoperative stroke rate. External carotid artery repair may not be clinically relevant. Disclosure: Nothing to disclose