Impact of the type of anesthesia on adverse events during transcarotid artery revascularization.

Publication/Presentation Date

8-21-2024

Abstract

OBJECTIVES: The use of local or regional anesthesia (LRA) is encouraged during transcarotid artery revascularization (TCAR) since the procedure is performed through a small incision. LRA permits neurologic evaluation during the procedure and may reduce periprocedural cardiac morbidity compared to general anesthesia (GA). There is limited and conflicting information regarding the preferred anesthesia to use during TCAR. We compared periprocedural clinical and technical complications, and intraprocedural performance metrics of TCAR performed under GA versus LRA.

METHODS: Patient, lesion, physician, and procedural information was collected in a worldwide quality assurance program of consecutive TCAR procedures. A composite clinical adverse event rate (death, stroke, transient ischemic attack, myocardial infarction) and a composite technical adverse event rate (aborted procedure, conversion to carotid endarterectomy, bleeding, dissection, cranial-nerve injury, device failure) in the periprocedural period were computed. Four intraprocedural performance measures (flow-reversal time, fluoroscopy time, contrast volume, and skin-to-skin time) were recorded. Deidentified data were analyzed independently at the Center for Vascular Research, Univ of Maryland. Poisson regressions were used to assess the impact of anesthesia type on adverse event rates. Linear regressions were used to compare performance measures.

RESULTS: A total of 27,043 TCARs were performed by 1,456 physicians between 2012 and 2021. A majority (83%) of patients received GA, and this proportion increased over time (R

CONCLUSIONS: Almost 2/3

ISSN

1097-6809

Disciplines

Medicine and Health Sciences

PubMedID

39179003

Department(s)

Department of Surgery

Document Type

Article

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