Purpose: To determine the safety and efficacy of local anesthesia for
percutaneous carotid angioplasty and stenting performed via a direct c
ommon carotid access. Methods: Deep cervical plexus blockade was used
for anesthesia in 22 of 32 patients (26 males; mean age 66 years) unde
rgoing percutaneous carotid balloon angioplasty and/or stenting via di
rect carotid puncture. Local anesthesia was selected according to pati
ent preference (n = 9); advanced age (n = 4); ischemic heart disease (
n = 4); intended extracorporeal circulation for unstable angina (n = 3
); and an incompetent circle of Willis (n = 2). The technique involved
injection of bupivacaine hydrochloride along the C2, C3, and C4 trans
verse processes. No superficial cervical plexus blockade was used. Res
ults: No complications of anesthesia were observed, though there were
cases in which surgery became necessary under local anesthesia for ang
ioplasty-related complications. These conversions were accomplished wi
thout difficulty. Conclusions: Cervical nerve blockade appears to be a
safe and effective anesthetic method for endovascular carotid interve
ntions performed percutaneously through direct carotid puncture.