Objectives: This study aims to present our personal single-surgeon experience regarding carotid endarterectomy (CEA) procedures
performed 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 of
10 mL of 2% prilocaine. An awake test was performed for three min following arterial clamping. Arteriotomy line was closed primarily in
a 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 bypass
grafting 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. Two
patients (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 unilateral
carotid stenosis. This technique also allows implementation of a staged procedure early after the operation.
Key words: Carotid endarterectomy, carotid stenosis, local anesthesia.
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