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Anesthesia type determines risk of cerebral infarction after carotid endarterectomy.
J Vasc Surg. 2019 07; 70(1):138-147.JV

Abstract

OBJECTIVE

Silent and symptomatic cerebral infarctions occur in up to 34% of patients after carotid endarterectomy (CEA). This prospective study compared the risk of new brain infarctions detected by magnetic resonance imaging (MRI) in patients with internal carotid artery stenosis undergoing CEA with local anesthesia (LA) vs general anesthesia (GA).

METHODS

Consecutive patients with internal carotid artery stenosis indicated for CEA were screened at two centers. Patients without contraindication to LA or GA were randomly allocated to the LA or GA group by ZIP code randomization. Brain MRI was performed before and 24 hours after CEA. Neurologic examination was performed before and 24 hours and 30 days after surgery. The occurrence of new infarctions on the control magnetic resonance images, stroke, transient ischemic attack, and other complications was statistically evaluated.

RESULTS

Of 210 randomized patients, 105 underwent CEA with LA (67 men; mean age, 68.3 ± 8.1 years) and 105 with GA (70 men; mean age, 63.4 ± 7.5 years). New infarctions were more frequently detected on control magnetic resonance images in patients after CEA under GA compared with LA (17.1% vs 6.7%; P = .031). Stroke or transient ischemic attack occurred within 30 days of CEA in three patients under GA and in two under LA (P = 1.000). There were no significant differences between the two types of anesthesia in terms of the occurrence of other complications (14.3% for GA and 21.0% for LA; P = .277).

CONCLUSIONS

The risk of silent brain infarction after CEA as detected by MRI is higher under GA than under LA.

Authors+Show Affiliations

Department of Neurosurgery, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic.Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Ostrava, Ostrava, Czech Republic.Department of Neurosurgery, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic.Department of Neurosurgery, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic.Department of Neurosurgery, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic.Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Ostrava, Ostrava, Czech Republic.Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic.Department of Neurosurgery, Military University Hospital, Praha, Czech Republic.Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic.Center for Science and Research, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic.Center for Science and Research, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic; Department of Neurology, Comprehensive Stroke Center, University Hospital Ostrava, Ostrava, Czech Republic. Electronic address: skoloudik@hotmail.com.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30792052

Citation

Orlický, Michal, et al. "Anesthesia Type Determines Risk of Cerebral Infarction After Carotid Endarterectomy." Journal of Vascular Surgery, vol. 70, no. 1, 2019, pp. 138-147.
Orlický M, Hrbáč T, Sameš M, et al. Anesthesia type determines risk of cerebral infarction after carotid endarterectomy. J Vasc Surg. 2019;70(1):138-147.
Orlický, M., Hrbáč, T., Sameš, M., Vachata, P., Hejčl, A., Otáhal, D., Havelka, J., Netuka, D., Herzig, R., Langová, K., & Školoudík, D. (2019). Anesthesia type determines risk of cerebral infarction after carotid endarterectomy. Journal of Vascular Surgery, 70(1), 138-147. https://doi.org/10.1016/j.jvs.2018.10.066
Orlický M, et al. Anesthesia Type Determines Risk of Cerebral Infarction After Carotid Endarterectomy. J Vasc Surg. 2019;70(1):138-147. PubMed PMID: 30792052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anesthesia type determines risk of cerebral infarction after carotid endarterectomy. AU - Orlický,Michal, AU - Hrbáč,Tomáš, AU - Sameš,Martin, AU - Vachata,Petr, AU - Hejčl,Aleš, AU - Otáhal,David, AU - Havelka,Jaroslav, AU - Netuka,David, AU - Herzig,Roman, AU - Langová,Kateřina, AU - Školoudík,David, Y1 - 2019/02/18/ PY - 2018/06/06/received PY - 2018/10/04/accepted PY - 2019/2/23/pubmed PY - 2020/1/28/medline PY - 2019/2/23/entrez KW - Carotid artery KW - Endarterectomy KW - General anesthesia KW - Local anesthesia KW - Magnetic resonance SP - 138 EP - 147 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 70 IS - 1 N2 - OBJECTIVE: Silent and symptomatic cerebral infarctions occur in up to 34% of patients after carotid endarterectomy (CEA). This prospective study compared the risk of new brain infarctions detected by magnetic resonance imaging (MRI) in patients with internal carotid artery stenosis undergoing CEA with local anesthesia (LA) vs general anesthesia (GA). METHODS: Consecutive patients with internal carotid artery stenosis indicated for CEA were screened at two centers. Patients without contraindication to LA or GA were randomly allocated to the LA or GA group by ZIP code randomization. Brain MRI was performed before and 24 hours after CEA. Neurologic examination was performed before and 24 hours and 30 days after surgery. The occurrence of new infarctions on the control magnetic resonance images, stroke, transient ischemic attack, and other complications was statistically evaluated. RESULTS: Of 210 randomized patients, 105 underwent CEA with LA (67 men; mean age, 68.3 ± 8.1 years) and 105 with GA (70 men; mean age, 63.4 ± 7.5 years). New infarctions were more frequently detected on control magnetic resonance images in patients after CEA under GA compared with LA (17.1% vs 6.7%; P = .031). Stroke or transient ischemic attack occurred within 30 days of CEA in three patients under GA and in two under LA (P = 1.000). There were no significant differences between the two types of anesthesia in terms of the occurrence of other complications (14.3% for GA and 21.0% for LA; P = .277). CONCLUSIONS: The risk of silent brain infarction after CEA as detected by MRI is higher under GA than under LA. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30792052/Anesthesia_type_determines_risk_of_cerebral_infarction_after_carotid_endarterectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)32486-8 DB - PRIME DP - Unbound Medicine ER -