General Vs Local Anaesthesia for Patients Undergoing Carotid Endarterectomy With A Contralateral Carotid Artery Occlusion. A Systematic Review

Introduction: Patients undergoing CEA with contralateral carotid occlusion have a higher risk of stroke. Performing a CEA under locoregion anaesthetic (LA) has potential to detect intraoperative neurological events. Aim: We aim to review the efectiveness of locoregional versus general anaesthetic (GA) in patients undergoing CEA, with a concomitant contralateral carotid occlusion. Primary outcome measures of perioperative stroke, TIA, myocardial infarction, death were assessed. Method: This review was conducted in accordance with PRISMA guidelines. Online electronic databases Pubmed, Embase, Medline and Cochrane Library Central Register of Controlled Trials were searched. Randomised controlled trials and controlled clinical trials assessing patients with carotid artery stenosis 50% (regardless of symptoms) with occlusion of the contralateral carotid artery undergoing CEA under GA or LA were included. Data was extracted using Covidence for analysis in Review Manager (RevMan 5). Results: A total of 1,129 references were identifed with 516 duplicates removed. 612 studies were screened by two reviewers. One paper matching eligibility criterion was included for analysis. Data from this trial demonstrated 310 CEAs performed on patients with a contralateral carotid artery occlusion; 150 and 160 of which were performed under GA and LA respectively. There were fewer primary events in the LA group (8 [5%] versus 15 [10%]). Conclusion: This review revealed one high quality RCT demonstrating favourable outcomes of LA versus GA in patients undergoing CEA with a contralateral occlusion. There is a paucity of evidence to suggest superiority of one modality of anaesthesia in patients undergoing CEA with a contralateral carotid artery occlusion.