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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carotid endarterectomy (CEA) is of benefit for stroke prevention in the presence of severe carotid stenosis, provided surgical morbidity and mortality are acceptably low. To assess the current performance of CEA in the UK, an interim analysis of 30-day postoperative outcome data, blinded to anaesthetic allocation, from the first 1,001 UK patients randomised in the GALA Trial (multicentre randomised trial of general versus local anaesthesia for CEA) took place and the time from last symptomatic event to surgery was recorded. The 30-day risk of stroke was 5.3%, myocardial infarction (MI) 0.4%, death 1.7%, and stroke, MI or death 6.4%. Median delay between symptoms and surgery was 82 days. These risks are similar to those reported in the large randomised trials of CEA, but current delays to surgery are excessive and must have substantially reduced the benefit of endarterectomy.
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PMID:Carotid endarterectomy in the UK: acceptable risks but unacceptable delays. 1819 7

There are still some vascular surgeons who do not use carotid patching routinely in all patients undergoing CEA, however, based on the data presented in this review, there is Level 1 evidence to support the routine use of carotid patching. Meanwhile, there is no Level 1 evidence to support selective patching for CEA, however a Grade D recommendation may be used to recommend that primary closure can be safely practiced in a large ICA (>6mm). A meta-analysis/systemic review of well-conducted prospective randomized trials (Level 1 evidence) concluded that there was no difference in stroke/death rates between conventional CEA with patch closure and eversion CEA. The incidence of significant restenosis with eversion CEA is also similar to CEA with patch closure, however eversion CEA had a lower restenosis rate than patients undergoing CEA with primary closure. Prior to the GALA trial, there was insufficient evidence from randomized clinical trials comparing CEA under local anesthesia versus general anesthesia to support the superiority of either technique in reducing major perioperative events, i.e. stroke, MI, or death. However, the GALA trial concluded that the perioperative stroke/MI and death rates were equivalent in both techniques.
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PMID:Processes of care for carotid endarterectomy: surgical and anesthesia considerations. 1966 Aug 99

Cardiovascular diseases are associated with high rates of morbidity and mortality. Carotid artery stenosis causes between 20% and 25% of ischemic strokes, especially when an embolism is the underlying cause. Carotid endarterectomy is the treatment of choice when stenosis exceeds 60%. It is important to have an understanding of how to manage perioperative factors that can decrease the risk of stroke, infarction, and death. In contrast to the findings of earlier meta-analyses, the recent GALA trial of general versus local anesthesia concluded that the rates of stroke, myocardial infarction, and mortality during or soon after surgery are similar for both types of anesthesia.
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PMID:[Anesthesia for carotid endarterectomy: a review]. 2134 15

Like the earlier multicenter General Anesthesia (GA) versus Local Anaesthesia (LA) for carotid surgery (GALA) trial, a recent independent study showed no difference in transient ischemic attack, stroke, myocardial infarction, and death rates between carotid endarterectomy (CEA) performed under LA compared with GA. Besides these outcomes, however, several additional issues may be of interest when comparing the 2 modalities. Examples include the occurrence of post-CEA patient delirium, cognitive dysfunction, and health-related quality of life, as well as the cost-effectiveness, length of hospitalization, and resource utilization. This commentary discusses and compares these outcomes of CEA performed under LA versus GA.
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PMID:Local versus general anesthesia for carotid endarterectomy: issues beyond stroke, myocardial infarction, and death rates. 2221 Jul 36

Anesthesia for carotid endarterectomy (CEA), general or locoregional, has been an issue of debate in literature ever since the first Cochrane review in 1991. The largest available study on the subject, the GALA trial, has not shown any difference in patient's outcome - incidence of stroke and 30-day-mortality postsurgery. However, increasing evidence favors regional anesthesia as an independent factor of reduced morbidity after CEA. The advantages and disadvantages of general versus regional anesthesia for CEA have been well established. Cervical plexus blocks (CPBs) are safe and effective anesthetic techniques, but they may also present adverse effects that we must be aware of. Optimal cerebral function monitoring remains a problem to be solved. Cerebral oximetry may prove to be a reliable tool in predicting neurological impairment. This narrative review intends to highlight the latest implemented anesthetic modalities for CEA, including CPB under ultrasound guidance, and to outline the main limitations of general versus regional anesthesia. Following the appropriate anesthetic, modality necessitates a thorough preoperative consultation among the patient, the surgeon, and the anesthetist. The anesthetic plan should be made on an individual basis, taking into consideration patient's comorbidities and wish.
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PMID:General versus local anesthesia for carotid endarterectomy: Special considerations. 3042 45