Postoperative Myocardial Infarction Rate Is Not Increased for Carotid Endarterectomy Under Local Anesthesia Compared to Carotid Stenting
Objective(s): Carotid artery stenting has been described as a minimally invasive modality for carotid artery stenosis treatment since its introduction in 1994. The CREST study came to establish carotid artery stenting as an effective modality for treatment of carotid artery stenosis as compared to carotid endarterectomy with a lower postoperative myocardial infarction rate at the expense of postoperative stroke. Our study investigated the three available modalities to compare the postoperative myocardial infarction rate for carotid artery stenting compared with carotid endarterectomy in its two modalities general and local anesthesia.
Methods: A retrospective study was conducted at a large tertiary care center for patients undergoing carotid artery stenting, carotid endarterectomy under local anesthesia, and carotid endarterectomy under general anesthesia. 30-day post-operative myocardial infarctions and strokes were evaluated for the different subgroups. Fisher’s exact test was used to calculate the outcomes amongst the different modalities.
Results: A total of 1127 procedures were included in the analysis with 421 for carotid endarterectomies performed under general anesthesia, 611 for carotid endarterectomies performed under local anesthesia and 95 for carotid artery stenting. Age distribution was not significantly different among study groups. No significant difference in postoperative myocardial infarction was encountered between carotid artery stenting and carotid endarterectomy under local anesthesia (0.2% v. 1.1%, p=0.25). Carotid endarterectomy under general anesthesia group was found to have a significantly higher risk of myocardial infarction as compared to local anesthesia group (1.2% v. 0.2%, p=0.44).
Conclusions: Our evidence suggests that carotid endarterectomy under local anesthesia does not have an increased risk of myocardial infarction as compared to carotid artery stenting.
Kfoury E, Leng D, Hashemi H, Mukherjee D. Postoperative myocardial infarction rate is not increased for carotid endarterectomy under local anesthesia compared to carotid stenting. Journal of Vascular Surgery, Sep 2012, 56(3), 895.