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Anesthesia for carotid endarterectomy and carotid stenting

John Augoustides, MD, FASE, FAHA
Jacob T Gutsche, MD
Section Editor
Peter D Slinger, MD, FRCPC
Deputy Editor
Nancy A Nussmeier, MD, FAHA


Carotid arterial atherosclerosis is a common cause of stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are both established revascularization interventions [1,2]. This topic will review the anesthetic management of patients undergoing elective CEA or CAS, utilizing the options of either general anesthesia or local/regional anesthesia [3,4].

The indications for carotid revascularization and the surgical considerations in selecting treatment with CEA or CAS are reviewed elsewhere [1,2,5]. (See "Management of asymptomatic carotid atherosclerotic disease" and "Management of symptomatic carotid atherosclerotic disease" and "Carotid endarterectomy" and "Carotid artery stenting and its complications".)


Cardiovascular comorbidity — A major focus of the preanesthesia evaluation is to detect and optimize cardiac conditions. Many patients presenting for carotid interventions have coexisting coronary atherosclerosis and increased risk for perioperative morbidity due to myocardial ischemia [6]. A 12-lead electrocardiogram should be routinely performed for all patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS). Further consultation with a cardiologist may be warranted in patients with severe or unstable heart disease. (See "Evaluation of cardiac risk prior to noncardiac surgery" and "Management of cardiac risk for noncardiac surgery" and "Noncardiac surgery in patients with aortic stenosis".)

Medications — Appropriate perioperative medication management reduces cardiovascular risk and minimizes thrombotic complications.

Statins and beta blockers should be continued in patients already receiving these therapies. (See "Management of cardiac risk for noncardiac surgery", section on 'Statins' and "Management of cardiac risk for noncardiac surgery", section on 'Beta blockers'.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 04, 2017.
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