Carotid endarterectomy in conscious patient

Abstract

Objective: To evaluate morbidity and mortality of carotid endarterectomy performed under regional cervical block, taking into account duration of surgery, use of shunt, conversion to general anesthesia, surgical complications, stay of patients in the intensive care unit (ICU) and in the hospital, and patients' evolution over one year. Methods: From June 1998 to January 2004, 67 operations were performed on 61 patients with 70% or greater internal carotid stenosis, diagnosed by Doppler and confirmed by carotid angiography. Neurologic monitoring consisted of continuous assessment of alertness and motor activity of patients during the operation. The mean age was 69.7 years old. Regarding concomitant pathologies, 45 (47%) had hypertension; 21 (22%) coronary artery disease; 17 (18%) diabetes and 12 (13% ) pneumopathy. Results: There were three (4.48%) cases of bilateral carotid disease, for which surgery was performed at different times. The mean duration of surgery was 120 minutes. The use of a shunt was necessary in six (8.95%) cases and to convert to general anesthesia in two (2.98%). Two (2.98%) patients evolved with mental confusion after surgery and one (1.49%) presented infection of surgical site. Restenosis occurred in three (4.48%) cases. The mean times in the ICU and hospital were 1.34 and 4.20 days, respectively. There were no deaths, strokes or acute myocardial infarctions. Conclusion: Carotid endarterectomy with conscious patients is a good alternative for selected patients at high surgical risk for general anesthesia.