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(Stroke. 2005;36:169.)
© 2005 American Heart Association, Inc.

Cochrane Corner

Local Versus General Anaesthetic for Carotid Endarterectomy

From the Department of Surgery (K.R.), Chiang Mai University, Chiang Mai, Thailand; and the Stroke Prevention Research Unit (R.B., P.M.R.), University of Oxford, Oxford, UK.

Correspondence to Prof Peter Rothwell, Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom. E-mail peter.rothwell@clneuro.ox.ac.uk

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Carotid endarterectomy (CEA) markedly reduces the risk of stroke in people with recently symptomatic 70% to 99% carotid artery stenosis and to a lesser extent in people with 50% to 69% stenosis. However, benefit is dependent on maintaining a low operative risk, which may depend to some extent on the type of anesthetic used. Nonrandomized comparisons suggest that CEA under local anesthesia (LA) is associated with a lower operative risk of stroke and death than CEA under general anesthesia (GA), but such data are potentially unreliable and randomized studies are required.

Objectives

The aim of this review was to assess the operative risks of CEA under LA compared with CEA under GA.

Search Strategy

Two reviewers independently searched MEDLINE (1966 to April 2003), EMBASE (1980 to 2002), and Index to Scientific and Technical Proceedings (1980 to 1994). We also searched the Stroke Group trials register (April 2003), hand-searched 13 relevant journals up to 2002, and searched the reference lists of articles identified. We also advertised the review in Vascular News in August 2001.

Selection Criteria

Criteria included randomized trials and nonrandomized studies comparing CEA under LA versus GA.

Data Collection and Analysis

One reviewer selected studies for inclusion and another independently checked the decisions. Two reviewers assessed trial quality and independently extracted the data.

Main Results

Seven randomized trials involving 554 operations and 41 nonrandomized studies involving 25 622 operations were included. Eleven of the nonrandomized studies were prospective and 29 reported on a consecutive series of patients, but the methodological quality of many of the nonrandomized trials was questionable. In . . . [Full Text of this Article]