Anesthesia type determines risk of cerebral infarction after carotid endarterectomy
Language English Country United States Media print-electronic
Document type Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
30792052
DOI
10.1016/j.jvs.2018.10.066
PII: S0741-5214(18)32486-8
Knihovny.cz E-resources
- Keywords
- Carotid artery, Endarterectomy, General anesthesia, Local anesthesia, Magnetic resonance,
- MeSH
- Carotid Artery, Internal diagnostic imaging surgery MeSH
- Asymptomatic Diseases MeSH
- Time Factors MeSH
- Anesthesia, General adverse effects MeSH
- Cerebral Infarction diagnostic imaging etiology MeSH
- Diffusion Magnetic Resonance Imaging MeSH
- Risk Assessment MeSH
- Endarterectomy, Carotid adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Anesthesia, Local adverse effects MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Carotid Stenosis complications diagnostic imaging surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
- Geographicals
- Czech Republic MeSH
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.
Department of Neurosurgery J E Purkinje University Masaryk Hospital Ústí nad Labem Czech Republic
Department of Neurosurgery Military University Hospital Praha Czech Republic
Department of Radiology University Hospital Ostrava Ostrava Czech Republic
References provided by Crossref.org
ClinicalTrials.gov
NCT02398734
