Carotid endarterectomy using regional anesthesia in high-risk patients

Objective: We elected to compare the clinical outcomes of carotid endarterectomy (CEA) patients who were thought to be at increased risk for perioperative complications because of advanced age (>79 years), medical comorbidities and contralateral internal carotid artery occlusion to patients without these risk factors. Methods: A prospective series of 875 CEAs done using regional anesthesia were analyzed. All patients were operated upon under the direction of one neurosurgeon (REH). Clinical outcomes measures evaluated were any stroke, death or myocardial infarction within 30 days of operation. All patients were followed to a clinical endpoint and/or 6 weeks postoperatively. The incidence of adverse clinical outcomes in the suspected high-risk patients was compared to the incidence in the entire series using contingency table analysis (chi-square and Fisher's exact test). Results: A total of 20 strokes (2.3%), 4 myocardial infarctions (0.5%) and 3 deaths (0.3%) occurred within 30 days of CEA. None of the suspected risk factors was associated with a significantly (P<0.05) increased risk of perioperative morbidity or mortality. Conclusion: CEA using regional anesthesia can be performed in patients with advanced age, diabetes mellitus, atherosclerotic coronary vascular disease and contralateral ICA occlusion with acceptably low perioperative morbidity.