Impact of anesthesia type on results of carotid endarterectomy: analytical review of randomized clinical trials

Searching for optimal anesthesia type in patients undergoing carotid endarterectomy (CEA) has been ongoing since the origin of carotid surgery. Nevertheless, there is still no consensus on this issue. This review of randomized clinical trials (RCTs) defines the impact of anesthesia type - general anesthesia (GA) vs. regional anesthesia (RA) - on results of CEA. We found no significant difference in perioperative rate of major adverse cardiovascular events between CEA under GA and CEA under RA. Cumulative frequency of carotid intravascular shunting was much more high in patients who underwent CEA under GA (897/2044, 43.9% vs. 279/2068, 13.5%). However, clinical significance of the aforementioned difference is debatable due to variable indications and often unfounded criteria for intravascular shunting following CEA under GA. The article also highlights the features of perioperative hemodynamic status depending on anesthesia type. However, actual impact of hemodynamic status on perioperative outcomes was not assessed in the RCTs reviewed. Despite the progress in searching for optimal method of anesthesia for CEA, debate continues in community of carotid surgery experts between proponents of GA and RA. Indeed, available RCTs are characterized by some limitations not allowing them to fully disclose appropriate problems. This highlights the need for further research and systematization of available knowledge to determine the most effective and safe method of anesthesia for CEA.