Carotid endarterectomy under local anesthesia: An institutional report of experience

Özet

Objectives: This study aims to present our personal single-surgeon experience regarding carotid endarterectomy (CEA) proceduresperformed under local anesthesia.Patients and methods: Between January 2007 and December 2012, a total of 215 CEA procedures in 203 patients (164 males, 39 females;mean age 66.5±7.9 years; range, 43 to 85 years) were retrospectively analyzed. Local anesthesia was achieved with single bolus injection of10 mL of 2% prilocaine. An awake test was performed for three min following arterial clamping. Arteriotomy line was closed primarily ina continuous fashion. An intraluminal shunt was used in patients who developed neurological symptoms during the awake clamp testing.Results: Twelve patients (5.9%) underwent staged CEA for bilateral disease and 88 patients (43.3%) underwent coronary artery bypassgrafting following the initial CEA. None of procedures converted to general anesthesia. Transient ischemic attack developed in five patients(2.4%), cerebral infarction in five patients (2.4%), myocardial infarction in two patients (0.98%), and a neck hematoma in six patients (2.9%).Revision for neck hematoma within the first 24 hours was required in two patients (0.98%). The mean follow-up was 40.1±6.6 months. Twopatients (0.98%) had significant restenosis within two years and one of them underwent repeated CEA. There were five late mortalities(2.4%). The patency rate was 99% during follow-up.Conclusion: Low complication rates and excellent patency rates can be achieved using local anesthesia during CEA for isolated unilateralcarotid stenosis. This technique also allows implementation of a staged procedure early after the operation.