Postoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt

Abstract

Published data suggest that the regional anesthetic technique used for carotid endarterectomy (CEA) increases the systolic arterial blood pressure and heart rate. At the same time local anesthesia reduced the shunt insertion rate. This study aimed to analyze risk factors and ischemic symptomatology in patients with postoperative internal carotid artery restenosis. The current retrospective study was undertaken to assess the results of CEA in 8000 patients who were operated during a five-year period in six regional cardiovascular centers. Carotid color coded flow imaging, medical history, clinical findings and atherosclerotic risk factors were analyzed. Among them, there were 33 patients (0.4%) with postoperative re-occlusion after CEA. The patients with restenosis were re-examined with carotid color coded flow imaging and data were compared with 33 consecutive patients with satisfactory postoperative findings to serve as a control group. In the restenosis group eight risk factors were analyzed (hypertension, smoking, hyperlipidemia, diabetes mellitus, history of stroke, transitory ischemic attack, heart attack and coronary disease), and compared with risk factors in control group. Study results suggested that early postoperative internal carotid artery restenosis was not caused by atherosclerosis risk factors but by intraoperative shunt usage.

A lipid-poor plaque and asymptomatic status in women are associated with higher peak systolic velocity on duplex ultrasound after carotid endarterectomy

“…These factors were: sex [14,15], age [16], hypertension [17,18], current smoking [19,20], diabetes [15,21], body mass index [17], acetylsalicylic acid and statin use [14], symptom status [14,16], type of patch used [4,14,19], presence of contralateral stenosis [4,14], and operation year. The latter was included because in recent research in the Athero-Express biobank, it was found that plaque characteristics have changed over time during the total inclusion period [22].…”

Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy

“…Selective shunting has been related to postoperative cognitive dysfunction [4]. Better cognitive outcomes have been observed following CEA under regional anaesthesia [28] and, in addition, cardiac and pulmonary morbidity associated with general anaesthesia can be avoided.…”

“…However, the use of a shunt makes the operation technically more demanding and carries potential complications such as embolism or damage to arterial walls. Shunt insertion has also been related to postoperative internal carotid artery (ICA) re-stenosis after CEA [4] and to subclinical neurocognitive dysfunction [5], although the literature also shows controversy. In this context, it would be an advantage to preoperatively predict which patient will need a shunt.…”

The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study

“…However, it may on the other hand result in intraoperative embolism or damage of the vessel wall. Moreover, a large retrospective study indicated that intraoperative shunting may increase the long-term restenosis rate after CEA 16 . There is no guideline for intraoperative shunting to date; some surgeons advocate routine shunting for fear of the serious risk of cerebral hypoperfusion 17,18 .…”