Background: In the present study the perioperative complication rate is compared between high- and low-risk patients when carotid endarterectomy (CEA) is routinely performed under local anaesthesia (LA).
Patients and methods: From January 2000 through June 2008 1220 consecutive patients underwent CEA under LA. High-risk patients fulfilled at least one of the following characteristics: ASA 4 classification, "hostile neck", recurrent ICA stenosis, contralateral ICA occlusion, age > or = 80 years. The combined complication rate comprised any new neurological deficit (TIA or stroke), myocardial infarction or death within 30 days after CEA, which was compared between patient groups.
Results: Overall 309 patients (25%) were attributed to the high-risk group, which differed significantly regarding sex distribution (more males: 70% vs. 63%, p = 0.011), neurological presentation (more asymptomatic: 72% vs. 62%, p = 0.001) and shunt necessity (33% vs. 14%, p < 0.001). In 32 patients 17 TIAs and 15 strokes were observed. In 3 patients a myocardial infarction occurred. Death occurred in one patient following a stroke and in another patient following myocardial infarction, leading to a combined complication rate of 2.9% (35/1220). In the multivariate analysis only previous neurological symptomatology (OR 2.85, 95% CI 1.38-5.91) and intraoperative shunting (OR 5.57, 95% CI 2.69-11.55) were identified as independent risk factors for an increased combined complication rate.
Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA.