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Locoregional anaesthesia and intraoperative angiography in carotid endarterectomy - 16-year results of a consecutive single-centre series

Published:October 10, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.10.002
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      Summary

      Objective

      The benefit of local (LA) over general (GA) anaesthesia and the rationale of intraoperative imaging strategies during carotid endarterectomy (CEA) is under debate. This study analyses the associations between patient characteristics, LA and intraoperative imaging strategies and the in-hospital stroke and death rates in elective CEA over a 16-years period.

      Patients and methods

      All consecutive patients treated by elective CEA between January 2004 and December 2019 (n=1.872, median 71 years, 70% male, 37% symptomatic) were included. All patients were neurologically assessed before and within 48 hours after CEA. The primary outcome event was the combined rate of any in-hospital stroke or death. Secondary outcome events were the combined rates of any in-hospital major stroke (modified Rankin scale [mRS] 3–5) or death, stroke, minor stroke (mRS 0-2), major stroke, and death alone. To detect changes over time, we analysed four quartiles (2004–2007, 2008–2011, 2012–2015, 2016–2019) of this cohort. Statistical analysis comprised trend tests, univariate and multivariable logistic regression.

      Results

      Median patient age increased from 68 to 73 years (p<0.0001). Over time, LA (from 28% to 91%) and intraoperative imaging (angiography, 2.8% to 98.1%, DUS, 0% to 78.2%) were applied more frequently. Surgical techniques did not change. The in-hospital stroke/death and major stroke/death rates decreased from 3.7% to 1.5% (p=0.04) and 2.8 to 0.9% (p=0.01), respectively, corresponding to a relative risk decline of 7% and 12% per year. Multivariable analysis revealed that LA (OR 0.25, 95%CI 0.1–0.62) and intraoperative angiography (OR 0.09, 95%CI: 0.10–0.81) were associated with lower in-hospital major stroke and death rates.

      Conclusions

      These data demonstrate a decline in the combined rates of any in-hospital major stroke or death after non-emergent CEA over time. Locoregional anaesthesia and intraoperative quality control were associated with these improvements and might be worthwhile in elective CEA.

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