Carotid endarterectomy under regional or general anesthesia — two methods of anesthesia in a multi-field hospital

Objective. To define the impact of anaesthesia (general [GA] vs. regional [RA]) on results of carotid endarterectomy (CEA). Material and methods. There were 1732 CEAs in 2012—2025. CEA under RA was performed in 1153 cases, CEA under GA — in 579 cases. The primary perioperative endpoints were ipsilateral ischemic stroke, any ischemic stroke, hyperperfusion-induced intracerebral haemorrhage, myocardial infarction, death and major adverse cardiovascular events (MACE). The secondary endpoints were clinically significant bleeding, carotid intravascular shunting, cranial nerve injury, postoperative pneumonia and conversion of RA to GA. Results. There were no significant between-group differences in the incidence of postoperative ipsilateral ischemic stroke+any other ischemic stroke (GA 2.8% [n=16] vs RA 2% [n=23]; p=0.309). Myocardial infarction was significantly more common in the GA group (GA 1% [n=6] vs RA 0.1% [n=1]; p=0.007). Postoperative in-hospital mortality was also significantly higher in the GA group (GA 1.9% [n=11] vs RA 0.6% [n=7]; p=0.012). Both groups did not differ in the incidence of hyperperfusion-induced intracerebral hematomas (GA 0% [n=0] vs. RA 0.3% [n=3]; p=0.555) or major adverse cardiovascular events (GA 4.1% [n=24] vs. RA 2.5% [n=29]; p=0.063). Carotid intravascular shunting was significantly more common in the GA group (GA 17.1% [n=99] vs. RA 7.8% [n=90]; p< 0.001). No significant differences were found for other outcomes. Conversion from regional to general anaesthesia occurred in 1.6% of cases. Conclusion. RA for CEA is safe and followed by low rate of conversion to general anaesthesia. When compared with GA, regional anaesthesia demonstrated significant advantages in key outcomes, including lower rates of myocardial infarction and in-hospital postoperative mortality. Carotid intravascular shunting was significantly less common in the RA group.