Carotid artery surgery under local anaesthesia: early results of 100 recent cases.

A prospective single-centre study was performed to evaluate the safety and efficacy of carotid revascularisation under local anesthesia. Between Novem ber 1, 1996 and March 30, 1998, 92 patients underwent surgery for 100 carot id artery stenoses under local cervical block anesthesia. Fifty-eight steno ses were asymptomatic and 42 were symptomatic. Duplex ultrasound scanning s howed a tight (n = 17) or very tight carotid artery stenosis (n = 83); angi ography showed 19 contralateral carotid artery stenosis and 30 hemodynamica lly significant stenosis of vertebral and/or subclavian arteries. Cerebral Magnetic Resonance Imaging (MRI) (N = 87) with circle of Willis Magnetic Re sonance Angiogram (MRA) (n = 83) detected 29 ischemic defects (33%). Fiftee n ischemic defects were found in 58 asymptomatic patients (26%). Circle of Willis was incomplete in 41%. Anesthesia was performed using superficial ce rvical block (n = 100). Endarterectomy was the most commonly used revascula risation technique in 86 cases with 5 eversion endarterectomies; carotid ve in or prothetic graft was used in 14%. In this study, there was no mortalit y, and no cardiac or neurologic complications, during the first postoperati ve month. Twelve patients experienced neurologic intolerance to carotid cla mping. This clamping-related ischemia required 4 shunts. All patients with clamping intolerance had a good clinical outcome after revascularisation wi th no objective or MRI sequelae. Incomplete circle of Willis on MRA was a s ignificant predictive test of clamping intolerance (p < 0.0001). Carotid ar tery surgery under local anesthesia reduces the cumulative mortality and mo rbidity rate (TCMM.) to a very low level: 0% in this study. These recent re sults are the modern reference for curent carotid artery surgery evaluation .