CHOICE OF ANESTHESIOLOGICAL CARE (GENERAL OR REGIONAL ANESTHESIA) FOR CAROTID ENDARTERECTOMY
TL;DR
There was no statistically significant difference in the incidence of perioperative stroke between OA and RA, however, RA was associated with a significant reduction in the risk of myocardial infarction, especially in patients with heart failure, and neuromonitoring was a key factor determining neurological safety.
Abstract
Carotid endarterectomy (CEAE) is the "gold standard" for stroke prevention in patients with hemodynamically significant carotid artery stenosis. The choice of anesthesia method — general (OA) or regional (RA) — remains a matter of debate, as it affects the risk of perioperative complications. This article analyzed 78 sources, including randomized controlled trials, prospective and retrospective cohorts, systematic reviews, and meta-analyses published through 2026. There was no statistically significant difference in the incidence of perioperative stroke between OA and RA. However, RA was associated with a significant reduction in the risk of myocardial infarction, especially in patients with heart failure. RA also correlated with shorter duration of surgery and hospitalization, but with more frequent hemodynamic fluctuations. The effectiveness of neuromonitoring (multimodal in OA and clinico-instrumental in RA) was a key factor determining neurological safety. Moderate hypothermia has shown potential in reducing postoperative cognitive impairment. Thus, the choice between OA and RA in CEAE should be personalized, based on the patient's dominant risk profile.