title: Combined Carotid Endarterectomy and Retrograde Stenting of the Supra-Aortic Trunk: Does Cervical Block Offer Advantages?
abstract: BACKGROUND
  Atherosclerosis of the carotid artery is a major source of stroke. In some cases, atherosclerosis occurs at several positions within the carotid artery. Carotid endarterectomy (CEA) in combination with retrograde balloon angioplasty and stenting of a brachiocephalic or common carotid artery stenosis has been described as efficacious and safe procedure to prevent stroke in these cases. The aim of this study was to analyze the impact of anesthetic techniques on hemodynamic factors, operation time, duration of clamping, and postoperative pain.
  
  
  METHODS
  A retrospective analysis of patients undergoing CEA in combination with retrograde stenting under either general anesthesia (GA) or cervical block (CB) was carried out. Preoperative risk factors were analyzed as well as operating and cross-clamping time, hemodynamic factors, perioperative complications, postoperative pain, application of pain killers, and duration of intensive care unit (ICU) and hospital stay.
  
  
  RESULTS
  Operating (GA: 193 ± 91 min vs. CB: 125 ± 52 min, P = 0.029) and cross-clamping time (GA: 34 ± 12 min vs. CB: 26 ± 9 min, P < 0.001) were shorter under CB. Patients under CB were hemodynamically more stable and required less norepinephrine (GA: 1.1 ± 0.6 mg vs. CB: 0.1 ± 0.1 mg, P < 0.001) and crystalloids (GA: 2,813 ± 1,173 mL vs. CB: 1,088 ± 472 mL, P < 0.001). Postoperative pain levels (GA: numeric rating scale 4.3/10 vs. 2.0/10; P = 0.004) and requirement of pain killers were also lower within the CB group.
  
  
  CONCLUSIONS
  Synchronous CEA and retrograde balloon angioplasty and stenting of a brachiocephalic or common carotid artery stenosis under CB is associated with reduction of operating and cross-clamping time, improved hemodynamical stability, lower postoperative pain, shorter ICU and hospital stay, and it offers the advantage of a continuous neurological monitoring.
authors.affiliation: Department of Anesthesiology, University of Munich (LMU), Munich, Germany. Electronic address: Jens.Heyn@med.uni-muenchen.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Heyn
authors.affiliation: Department of Vascular Surgery, Erding Hospital, Erding, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Rosch
authors.affiliation: Department of Radiology, University of Munich (LMU), Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Treitl
authors.affiliation: Department of Vascular Surgery, Erding Hospital, Erding, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Klose
authors.affiliation: Department of Anesthesiology, University of Munich (LMU), Munich, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Luchting
authors.affiliation: Department of Vascular Surgery, Erding Hospital, Erding, Germany; Department of Surgery, University of Munich (LMU), Munich, Germany.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Sadeghi-Azandaryani
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000768:Anesthesia, General / Q000009:adverse effects; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000503:physiopathology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics