title: Carotid endarterectomy in awake patients: safety, tolerability and results.
abstract: OBJECTIVE
  To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch.
  
  
  METHODS
  One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%).
  
  
  RESULTS
  A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%).
  
  
  CONCLUSIONS
  Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates.
authors.affiliation: Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Célio Teixeira
authors.initials: CT
authors.lastname: Mendonça
authors.affiliation: Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Jerônimo A
authors.initials: JA
authors.lastname: Fortunato
authors.affiliation: Hospital Universitário da Cruz Vermelha do Paraná/ Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Cláudio A de
authors.initials: CA
authors.lastname: Carvalho
authors.affiliation: Hospital Universitário da Cruz Vermelha do Paraná/ Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Janaina
authors.initials: J
authors.lastname: Weingartner
authors.affiliation: Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Otávio R M
authors.initials: OR
authors.lastname: Filho
authors.affiliation: Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Rezende
authors.affiliation: Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Luciane P
authors.initials: LP
authors.lastname: Bertinato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000792:Angiography; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D019990:Perioperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014851:Wakefulness