Clinical outcomes for patients at high risk who underwent carotid endarterectomy with regional anesthesia

OBJECTIVE: To compare the clinical outcomes for patients with carotid artery stenosis with advanced age, diabetes mellitus, atherosclerotic coronary vascular disease, and contralateral internal carotid artery occlusion who underwent carotid endarterectomy (CEA), using regional anesthesia, with the outcomes for patients without these risk factors. METHODS: A prospective series of 600 CEAs performed using regional anesthesia was analyzed. All patients were surgically treated under the direction of one neurosurgeon, in an academic medical center. Clinical outcome measures were any stroke, death, or cardiac morbidity within 30 days after surgery. All patients were monitored until a clinical end point was reached and/or 6 weeks had elapsed after surgery. The incidence of adverse clinical outcomes among the suspected high-risk patients was compared with the incidence for the entire series using contingency-table analysis (χ² and Fisher's exact tests). RESULTS: Fifteen strokes (2.5%), three cardiac complications (0.5%), and two deaths (0.3%) occurred within 30 days after CEA. None of the suspected risk factors was associated with a significantly (P < 0.05) increased risk of perioperative morbidity or death. CONCLUSION: CEA using regional anesthesia can be performed for patients with advanced age, diabetes mellitus, atherosclerotic coronary vascular disease, and contralateral internal carotid artery occlusion, with acceptably low perioperative morbidity rates.