title: Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.
abstract: OBJECTIVE
  During carotid endarterectomy (CEA), carotid cross-clamping is performed to allow for artery incision and plaque removal. A small subgroup of patients can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurologic deficit. These patients are described as having ''cross-clamp intolerance.'' The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition.
  
  
  METHODS
  From August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to internal carotid artery (ICA) occlusion for <30 seconds were considered to have cross-clamp intolerance.
  
  
  RESULTS
  Among the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in <30 seconds (i.e., these patients presented cross-clamp intolerance). The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion.
  
  
  CONCLUSIONS
  Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion.
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brazil. Electronic address: mdellaretti@mac.com.
authors.forename: Marcos
authors.initials: M
authors.lastname: Dellaretti
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Laura T
authors.initials: LT
authors.lastname: de Vasconcelos
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Jules
authors.initials: J
authors.lastname: Dourado
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Renata F
authors.initials: RF
authors.lastname: de Souza
authors.affiliation: Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Renato R
authors.initials: RR
authors.lastname: Fontoura
authors.affiliation: Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Atos A
authors.initials: AA
authors.lastname: de Sousa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods; D000772:Anesthesia, Local / Q000009:adverse effects* / Q000379:methods*; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Carotid endarterectomy; Carotid stenosis; Intolerance to cross-clamping; Regional anesthesia