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Ozbek IC, Durmaz A, Ozen Y, Demir S, Celik D, Yalcinkaya E, Cunurlu M, Ugur M. Effectiveness of carotid council in the treatment of carotid artery disease: Early-term outcomes of the multidisciplinary approach. Vascular 2024; 32:573-578. [PMID: 36655573 DOI: 10.1177/17085381231153222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Carotid arterial stenosis could be treated by surgical or percutaneous stenting. In this study, we aimed to investigate the effectiveness of the carotid council on the outcomes of patients with carotid artery disease. METHODS In this retrospective study, we analyzed the patients who had undergone carotid arterial revascularization from April 2014 to July 2022 in our hospital. All patients were evaluated in carotid council, which is constituted by neurologist, cardiologist and cardiovascular surgeon. Patient-specific treatment procedure was decided in the council. Demographics and early-term follow-up results of the patients were evaluated. RESULTS Totally 95 procedures in 85 patients were analyzed during the study period. 27.4 % of the patients had significant contralateral carotid arterial stenosis. In 88 (92.6%) procedures, patients were treated by carotid endarterectomy, and 5 procedures were performed under regional anesthesia. Shunt usage was 6.0% during the surgery, and arteriotomy was repaired with primary sutures in 87.3%. Stent implantation was performed in 7 patients. There were 5 neurological adverse events after the carotid endarterectomy and 2 neurological events were after carotid arterial stenting. In each treatment group, one patient died after the procedure. In the follow-up period, restenosis was observed just in a patient who was treated with carotid endarterectomy and primary repair. CONCLUSION Although carotid artery disease could be treated in accordance with the guidelines, treatment procedures should be patient-specific. Carotid councils might be helpful in giving patient-specific decisions, thereby providing the patient-based treatment procedure and improving the outcomes of the patients with carotid artery disease.
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Affiliation(s)
- Ismail C Ozbek
- Department of Cardiovascular Surgery, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aysegul Durmaz
- Department of Cardiovascular Surgery, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yucel Ozen
- Department of Cardiovascular Surgery, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serkan Demir
- Department of Neurology, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Didem Celik
- Department of Neurology, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Emre Yalcinkaya
- Department of Cardiology, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Cunurlu
- Department of Cardiovascular Surgery, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Ugur
- Department of Cardiovascular Surgery, Sancaktepe Sehit Professor Doctor Ilhan Varank Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Ristow AVB, Massière B, Meirelles GV, Casella IB, Morales MM, Moreira RCR, Procópio RJ, Oliveira TF, de Araujo WJB, Joviliano EE, de Oliveira JCP. Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease. J Vasc Bras 2024; 23:e20230094. [PMID: 39099701 PMCID: PMC11296686 DOI: 10.1590/1677-5449.202300942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 08/06/2024] Open
Abstract
Extracranial cerebrovascular disease has been the subject of intense research throughout the world, and is of paramount importance for vascular surgeons. This guideline, written by the Brazilian Society of Angiology and Vascular Surgery (SBACV), supersedes the 2015 guideline. Non-atherosclerotic carotid artery diseases were not included in this document. The purpose of this guideline is to bring together the most robust evidence in this area in order to help specialists in the treatment decision-making process. The AGREE II methodology and the European Society of Cardiology system were used for recommendations and levels of evidence. The recommendations were graded from I to III, and levels of evidence were classified as A, B, or C. This guideline is divided into 11 chapters dealing with the various aspects of extracranial cerebrovascular disease: diagnosis, treatments and complications, based on up-to-date knowledge and the recommendations proposed by SBACV.
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Affiliation(s)
- Arno von Buettner Ristow
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-RIO, Disciplina de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-RJ, Rio de Janeiro, RJ, Brasil.
| | - Bernardo Massière
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-RIO, Disciplina de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-RJ, Rio de Janeiro, RJ, Brasil.
| | - Guilherme Vieira Meirelles
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade Estadual de Campinas – UNICAMP, Hospital das Clínicas, Disciplina de Cirurgia do Trauma, Campinas, SP, Brasil.
| | - Ivan Benaduce Casella
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, São Paulo, SP, Brasil.
| | - Marcia Maria Morales
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Associação Portuguesa de Beneficência de São José do Rio Preto, Serviço de Cirurgia Vascular, São José do Rio Preto, SP, Brasil.
| | - Ricardo Cesar Rocha Moreira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-PR, Curitiba, PR, Brasil.
- Pontifícia Universidade Católica do Paraná – PUC-PR, Hospital Cajurú, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | - Ricardo Jayme Procópio
- Universidade Federal de Minas Gerais – UFMG, Hospital das Clínicas, Setor de Cirurgia Endovascular, Belo Horizonte, MG, Brasil.
- Universidade Federal de Minas Gerais – UFMG, Faculdade de Medicina, Belo Horizonte, MG, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-MG, Belo Horizonte, MG, Brasil.
| | - Tércio Ferreira Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SE, Aracajú, SE, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Walter Jr. Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-PR, Curitiba, PR, Brasil.
- Universidade Federal do Paraná – UFPR, Hospital das Clínicas – HC, Curitiba, PR, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Júlio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
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Demir T, Bektas N, Kasapoglu BO, Acar Sevinc S, Balta Basi N, Ozcelik F, Yalaz Tekan U, Koramaz I. Optimal cutoff value of carotid stump pressure for determining the need for a carotid shunt in carotid artery endarterectomy. Vascular 2023:17085381231174703. [PMID: 37148302 DOI: 10.1177/17085381231174703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This study was conducted to identify the diagnostic value of carotid stump pressure for determining the need for a carotid artery shunt in patients undergoing carotid artery endarterectomy. MATERIALS AND METHODS Carotid stump pressure was prospectively measured in all carotid artery endarterectomies performed under local anesthesia between January 2020 and April 2022. The shunt was selectively used when neurological symptoms appeared after carotid cross-clamping. Carotid stump pressure was compared between patients who needed shunting and those who did not. Demographic and clinical characteristics, hematological and biochemical parameters, and carotid stump pressure of the patients with and without shunts were statistically compared. To determine the optimal cutoff value and diagnostic performance of carotid stump pressure for identifying the patients who need a shunt, receiver operating characteristic analysis was performed. RESULTS Overall, 102 patients (61 men and 41 women) who underwent carotid artery endarterectomy under local anesthesia were included, with an age range of 51-88 years. A carotid artery shunt was used in 16 (8 men and 8 women) patients. The carotid stump pressure values of the patients with a shunt were lower than those without a shunt (median (min-max): 42 (20-55) vs 51 (20-104), p < 0.0006). In the receiver operating characteristic curve analysis performed to determine the need for a shunt, the optimal cutoff value of carotid stump pressure was ≤48 mmHg, sensitivity was 93.8%, and specificity was 61.6% (area under the curve: 0.773, p < 0.0001). CONCLUSION Carotid stump pressure has sufficient diagnostic power to determine the need for a shunt, but it cannot be used alone in the clinical setting. Instead, it can be used in combination with other neurological monitoring methods.
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Affiliation(s)
- Tolga Demir
- Department of Cardiovascular Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Nilufer Bektas
- Department of Cardiovascular Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Begum O Kasapoglu
- Department of Cardiovascular Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Sultan Acar Sevinc
- Department of Anesthesiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Nermin Balta Basi
- Department of Anesthesiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Fatih Ozcelik
- Department of Medical Biochemistry, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ulgen Yalaz Tekan
- Department of Neurology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ismail Koramaz
- Department of Cardiovascular Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Kline LA, Kothandaraman V, Knio ZO, Zuo Z. Effect of regional versus general anesthesia on thirty-day outcomes following carotid endarterectomy: a cohort study. Int J Surg 2023; 109:1291-1298. [PMID: 37057905 PMCID: PMC10389611 DOI: 10.1097/js9.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/13/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND The effect of regional versus general anesthesia on carotid endarterectomy outcomes is debated. This study assesses the effect of anesthetic technique on major morbidity and mortality and additional secondary endpoints following carotid endarterectomy. MATERIALS AND METHODS This was a retrospective propensity-matched-cohort analysis investigating elective carotid endarterectomy patients in the 2015-2019 American College of Surgeons National Surgical Quality Improvement Program ( n =37 204). The primary endpoint was 30-day mortality and major morbidity, defined as stroke, myocardial infarction, or death. Secondary endpoints included minor morbidity, bleeding events, healthcare resource utilization, and length of hospital stay. Univariate, multivariable, and survival analyses were applied. RESULTS The 1 : 1 propensity-matched-cohort included 8304 patients (4152 in each group). Regional anesthesia was associated with similar incidences of major morbidity and mortality [odds ratio (OR), 0.81 (95% CI, 0.61-1.09); P = 0.162] and unplanned resource utilization [OR, 0.93 (95% CI, 0.78-1.11); P = 0.443], but lower incidences of minor morbidity [OR, 0.60 (95% CI, 0.44-0.81); P < 0.001] and bleeding events [OR, 0.49 (95% CI, 0.30-0.78); P = 0.002], and a shorter length of hospital stay [1.4 vs. 1.6 days; mean difference, -0.16 days (95% CI, -0.25 to -0.07); P < 0.001]. On multivariable analysis, regional anesthesia remained independently predictive of minor morbidity [adjusted odds ratio (AOR), 0.58 (95% CI, 0.42-0.79); P = 0.001] and bleeding events [AOR, 0.49 (95% CI, 0.30-0.77); P = 0.003]. Significance was maintained on survival analysis for these two endpoints. A mortality benefit was observed on univariate [OR, 0.50 (95% CI, 0.25-1.00); P = 0.045], multivariable [AOR, 0.49 (95% CI, 0.24-0.96); P = 0.043], and survival analysis ( P = 0.045). CONCLUSIONS Carotid endarterectomy patients receiving regional anesthesia experience favorable outcomes compared to propensity-matched general anesthesia controls.
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Affiliation(s)
- Leigh A. Kline
- Department of Anesthesiology, University of Virginia Health
| | | | - Ziyad O. Knio
- Department of Anesthesiology, University of Virginia Health
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia Health
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Dakour-Aridi H, Gaber MG, Khalid M, Patterson R, Malas MB. Examination of the interaction between method of anesthesia and shunting with carotid endarterectomy. J Vasc Surg 2020; 71:1964-1971. [DOI: 10.1016/j.jvs.2019.08.248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/06/2019] [Indexed: 10/25/2022]
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6
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Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.703357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Awake Sedation With Propofol Attenuates Intraoperative Stress of Carotid Endarterectomy in Regional Anesthesia. Ann Vasc Surg 2020; 63:311-318. [DOI: 10.1016/j.avsg.2019.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 12/21/2022]
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8
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Harky A, Chan JSK, Kot TKM, Sanli D, Rahimli R, Belamaric Z, Ng M, Kwan IYY, Bithas C, Makar R, Chandrasekar R, Dimitri S. General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2019; 34:219-234. [PMID: 31072705 DOI: 10.1053/j.jvca.2019.03.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local anesthesia (LA) in CEA. DESIGN Systematic review and meta-analysis of comparative studies. SETTING Hospitals. PARTICIPANTS Adult patients undergoing CEA with either LA or GA. INTERVENTIONS The effects of GA and LA on CEA outcomes were compared. MEASUREMENTS AND MAIN RESULTS PubMed, OVID, Scopus, and Embase were searched to June 2018. Thirty-one studies with 152,376 patients were analyzed. A random effect model was used, and heterogeneity was assessed with the I2 and chi-square tests. LA was associated with shorter surgical time (weighted mean difference -9.15 min [-15.55 to -2.75]; p = 0.005) and less stroke (odds ratio [OR] 0.76 [0.62-0.92]; p = 0.006), cardiac complications (OR 0.59 [0.47-0.73]; p < 0.00001), and in-hospital mortality (OR 0.72 [0.59-0.90]; p = 0.003). Transient neurologic deficit rates were similar (OR 0.69 [0.46-1.04]; p = 0.07). Heterogeneity was significant for surgical time (I2 = 0.99, chi-square = 1,336.04; p < 0.00001), transient neurologic deficit (I2 = 0.41, chi-square = 28.81; p = 0.04), and cardiac complications (I2 = 0.42, chi-square = 43.32; p = 0.01) but not for stroke (I2 = 0.22, chi-square = 30.72; p = 0.16) and mortality (I2 = 0.00, chi-square = 21.69; p = 0.65). Randomized controlled trial subgroup analysis was performed, and all the aforementioned variables were not significantly different or heterogenous. CONCLUSION The results from this study showed no inferiority of using LA to GA in patients undergoing CEA. Future investigations should be reported more systematically, preferably with randomization or propensity-matched analysis, and thus registries will facilitate investigation of this subject. Anesthetic choice in CEA should be individualized and encouraged where applicable.
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Affiliation(s)
- Amer Harky
- Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom.
| | - Jeffrey Shi Kai Chan
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Thompson Ka Ming Kot
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | | | - Rashad Rahimli
- Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Zlatka Belamaric
- Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Marcus Ng
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ian Yu Young Kwan
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Christiana Bithas
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Ragai Makar
- Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom
| | | | - Sameh Dimitri
- Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom
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Anesthetic type and hospital outcomes after carotid endarterectomy from the Vascular Quality Initiative database. J Vasc Surg 2018; 67:1419-1428. [DOI: 10.1016/j.jvs.2017.09.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/12/2017] [Indexed: 11/21/2022]
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10
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Influence of gender and use of regional anesthesia on carotid endarterectomy outcomes. J Vasc Surg 2016; 64:9-14. [DOI: 10.1016/j.jvs.2016.03.406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 11/20/2022]
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Abstract
First reports on surgical treatment of cerebrovascular atherosclerosis date to the early 1950s. With advancements in surgical technique, carotid endarterectomy (CEA) has become the treatment of choice for patients with both symptomatic and asymptomatic severe carotid stenosis. Given the benefits that surgery offers beyond medical management, the number of CEA procedures continues to increase. The intraoperative management of patients undergoing CEA is challenging because of the combination of patient and surgical factors. This article explores and reviews the literature on anesthetic management and considerations of patients undergoing CEA.
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Affiliation(s)
- Andrey Apinis
- Cardiothoracic Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 2 10th Street, Bronx, NY 10467, USA.
| | - Sankalp Sehgal
- Cardiothoracic Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 2 10th Street, Bronx, NY 10467, USA
| | - Jonathan Leff
- Cardiothoracic Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 2 10th Street, Bronx, NY 10467, USA
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Abstract
Summary Regional anaesthesia is a popular choice for patients undergoing carotid endarterectomy (CEA). Neurological function is easily assessed during carotid cross-clamping; haemodynamic control is predictable; and hospital stay is consistently shorter compared with general anaesthesia (GA). Despite these purported benefits, mortality and stroke rates associated with CEA remain around 5% for both regional anaesthesia and GA. Regional anaesthetic techniques for CEA have improved with improved methods of location of peripheral nerves including nerve stimulators and ultrasound together with a modification in the classification of cervical plexus blocks. There have also been improvements in local anaesthetic, sedative, and arterial pressure-controlling drugs in patients undergoing CEA, together with advances in the management of patients who develop neurological deficit after carotid cross-clamping. In the UK, published national guidelines now require the time between the patient's presenting neurological event and definitive treatment to 1 week or less. This has implications for the ability of vascular centres to provide specialized vascular anaesthetists familiar with regional anaesthetic techniques for CEA. Providing effective regional anaesthesia for CEA is an important component in the armamentarium of techniques for the vascular anaesthetist in 2014.
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Affiliation(s)
- M D Stoneham
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - D Stamou
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - J Mason
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
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Teles R, Mansilha A. Vantagens da anestesia locoregional relativamente à anestesia geral na endarterectomia carotídea. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/s1646-706x(14)70052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ciccozzi A, Angeletti C, Guetti C, Pergolizzi J, Angeletti PM, Mariani R, Marinangeli F. Regional anaesthesia techniques for carotid surgery: the state of art. J Ultrasound 2014; 17:175-83. [PMID: 25177390 DOI: 10.1007/s40477-014-0094-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This review will analyse some aspects of regional anaesthesia (RA) for carotid endarterectomy (CEA), a surgical procedure which requires a strict monitoring of patient's status. RA remains an important tool for the anaesthesiologist. Some debates remain about type and definition of regional anaesthesia, efficacy and safety of the different cervical block techniques, the right dose, concentration and volume of local anaesthetic, the use of adjuvants, the new perspectives: ultrasonography, the future directions. METHODS A literature search was performed for journal articles in English language in the PubMed Embase and in The Cochrane Library database, from January 2000 to December 2013. The electronic search strategy contained the following medical subject headings and free text terms: local anaesthesia versus general anaesthesia for endarterectomy, superficial and deep cervical block, complications of cervical nerve block, ultrasound guidance of superficial and deep cervical plexus block. CONCLUSIONS The gold standard for RA will be achieved after overcoming a number of limitations by a more extensive use of ultrasonography, by combining general and regional anaesthesia, including conscious anaesthesia, by defining the appropriate volume, concentration and dosage of local agents and by addition of adjuvants.
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Affiliation(s)
- Alessandra Ciccozzi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Chiara Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Cristiana Guetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Joseph Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA ; Department of Anesthesiology, Georgetown University School of Medicine, Washington D.C, USA ; Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA USA ; Association of Chronic Pain Patients, Houston, TX USA
| | - Paolo Matteo Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Roberta Mariani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
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Ozaki CK, Sobieszczyk PS, Ho KJ, McPhee JT, Gravereaux EC. Evidence-based carotid artery-based interventions for stroke risk reduction. Curr Probl Surg 2014; 51:198-242. [PMID: 24767101 DOI: 10.1067/j.cpsurg.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/29/2014] [Indexed: 11/22/2022]
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Augoustides JGT. Advances in the management of carotid artery disease: focus on recent evidence and guidelines. J Cardiothorac Vasc Anesth 2012; 26:166-71. [PMID: 22221508 DOI: 10.1053/j.jvca.2011.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Indexed: 12/12/2022]
Abstract
Recent landmark randomized trials and society guidelines have significantly revised the management of carotid artery disease. Duplex ultrasonography is the recommended initial diagnostic test for the assessment of extracranial carotid artery stenosis. Carotid artery imaging is reasonable in select patients scheduled for coronary artery bypass graft (CABG) surgery. Carotid revascularization can be achieved safely and effectively with carotid endarterectomy or carotid artery stenting. Because each procedure has a different risk/benefit profile, the optimal approach is to match the particular patient to the intervention that maximizes outcome benefit. Carotid revascularization is recommended in patients scheduled for CABG surgery when the carotid artery stenosis is symptomatic and/or bilateral. Further trials are required to guide the management of asymptomatic unilateral carotid artery stenosis in patients undergoing CABG surgery. Aggressive medical therapy remains the gold standard for intracranial carotid artery disease because landmark trials have shown no outcome improvement with vascular bypass or percutaneous angioplasty and stenting. A large recent trial showed that local anesthesia, as compared with general anesthesia, for carotid endarterectomy has no major clinical outcome advantage. Although carotid artery stenting is associated with a reduced risk of myocardial ischemia, it still has important risks of stroke and hemodynamic instability that significantly affect clinical outcome. The timing and choice of carotid revascularization technique ultimately depends on multiple clinical factors.
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Affiliation(s)
- John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Current world literature. Curr Opin Anaesthesiol 2012; 25:629-38. [PMID: 22955173 DOI: 10.1097/aco.0b013e328358c68a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paraskevas KI, Mikhailidis DP, Oikonomou K, Verhoeven EL. Local Versus General Anesthesia for Carotid Endarterectomy. Angiology 2011; 63:405-8. [DOI: 10.1177/0003319711430828] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Like the earlier multicenter General Anesthesia (GA) versus Local Anaesthesia (LA) for carotid surgery (GALA) trial, a recent independent study showed no difference in transient ischemic attack, stroke, myocardial infarction, and death rates between carotid endarterectomy (CEA) performed under LA compared with GA. Besides these outcomes, however, several additional issues may be of interest when comparing the 2 modalities. Examples include the occurrence of post-CEA patient delirium, cognitive dysfunction, and health-related quality of life, as well as the cost-effectiveness, length of hospitalization, and resource utilization. This commentary discusses and compares these outcomes of CEA performed under LA versus GA.
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Affiliation(s)
- Kosmas I. Paraskevas
- Department of Vascular and Endovascular Surgery, Klinikum Nürnberg Süd, Nürnberg, Germany
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital Campus, University College London (UCL), University of London, London, UK
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, Klinikum Nürnberg Süd, Nürnberg, Germany
| | - Eric L. Verhoeven
- Department of Vascular and Endovascular Surgery, Klinikum Nürnberg Süd, Nürnberg, Germany
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