[Carotid endarterectomy in cervical block anesthesia in patients with occluded contralateral internal carotid artery].
BACKGROUND
The goal of modern carotid surgery is relief of symptoms, stroke prevention, improvement in quality of life, prevention of vascular dementia, and prolongation of lifetime.


OBJECTIVE
The objective of this paper was to compare the outcome of carotid endarterectomy in cervical block vs. general anesthesia in patients with occluded contralateral internal carotid artery (ICA).


METHODS
One hundred patients (76 male, 24 female, mean age 60.81 years) with occluded contralateral ICA were operated from 1997-2000. Neurological symptomatology, deficiency and stroke incidence were preoperatively analyzed in two groups. Duplex-scanning, angiograms and CT-scan confirmed the diagnosis. Risk factors analysis included hypertension, diabetes, lipid metabolism disorders, smoking and history of CAD, CABG and PAOD. Morbidity and mortality were used to compare the outcome of surgery in two groups.


RESULTS
There was no difference of age, gender and symptomatology between the groups. Paresis, TIA and dysphasia were most frequent. 70%-90% of ICA stenosis was seen in the majority of patients. Hypertension and smoking were dominant risk factors in these two groups. Eversion carotid endarterectomy was the most frequent technique used. In three cases out of nine that were operated under cervical block, the neurological symptoms developed just after clamping, so the intraluminal shunt was placed. Postoperative morbidity was 12% and mortality was 8%.


CONCLUSIONS
There was no difference of preoperative parameters, surgical technique and outcome in these two groups. Without other intraoperative monitoring, cervical block anesthesia might be an option in patients with the occlusion of the contralateral ICA. However, prospective studies involving more patients are needed.
Ilijevski
Nenad
N
Krivokapić
Borislav
B
Smiljanić
Blasko
B
Nenezić
Dragoslav
D
Popov
Petar
P
Sagić
Dragan
D
Radak
Djordje
D
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011183:Postoperative Complications; D012307:Risk Factors