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• W2804448650 abstract "Prior research has shown a higher risk of stroke/death with selective shunting during carotid endarterectomy (CEA) compared with routine shunting, which was mainly attributable to the surgeons inexperience. In this study, we aim to evaluate whether the anesthetic choice and intraoperative neuromonitoring method modify the risk of in-hospital stroke/death with each shunting approach. A retrospective analysis of patients who underwent CEA in the VQI database (2003-2017) was performed. Patients were divided into three groups: no shunting, routine shunting (RS), and selective shunting (SS; based on an intraoperative indication). In each group, the incidence of in-hospital stroke or death was compared between local/regional anesthesia (LA/RA), and general anesthesia (GA). The interaction between anesthesia technique and shunting approach was evaluated. Multivariate logistic regression analysis was performed adjusting for patients demographics (age, gender, race, ethnicity), symptomatic status, comorbidities (diabetes, hypertension, coronary artery disease, congestive heart failure, chronic kidney disease, prior bypass, endovascular intervention or amputation, degree of stenosis, prior contralateral CEA/carotid artery stenting), restenosis, presence of anatomic high-risk factors, emergency status, type of CEA (conventional vs eversion), patching, and contralateral occlusion. A total of 60,399 CEA cases were included: no shunting (48.4%), RS (47.5%), and SS (4.1%). Shunting was more likely performed under GA compared with RA/LA (55.8% vs 13.3%; P < .001), particularly RS (51.7% vs 8.5%; P < .001). SS was associated with 67% increased odds of in-hospital stroke/death compared with RS regardless of anesthetic technique (adjusted odds ratio, 1.67; 95% confidence interval, 1.23-2.28; P < .01). However, in both RS and SS, the incidence of stroke/death was higher when performed under RA/LA compared with GA (2.4% vs 1.1% and 4.9% vs 2.0%, respectively; P < .05; Fig 1). On multivariable adjustment, the interaction between anesthetic technique and shunting approach was significant (P < .05). Compared with GA, LA/RA was associated with double the risk of in-hospital stroke/death in patients who were RS (adjusted odds ratio, 2.1495% confidence interval, 1.15-3.99; P = .02) or SS (adjusted odds ratio, 2.3595% confidence interval, 1.17-4.73; P = .02; Fig 2). In the SS group, stroke/death was higher in awake patients compared with those monitored via electroencephalography and stump pressure (5.2% vs 2.2% and 2.1%, respectively; P = .03). However, there was no association between the neuromonitoring technique and the incidence of stroke/death after adjustment. Shunting during CEA is more frequently performed under GA. Whether routine or selective, shunting is more safely performed under GA. The exact cause of this difference is unknown; however, surgeons experience, comfort and technical ability might play an important role.Fig 2In-hospital stroke/death in routine and selective shunting compared with no shunting during carotid endarterectomy (CEA).View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W2804448650 date "2018-06-01" @default.
• W2804448650 modified "2023-09-23" @default.
• W2804448650 title "PC060. Does Anesthesia Technique Modify the Risk of Routine and Selective Shunting During Carotid Endarterectomy?" @default.
• W2804448650 doi "https://doi.org/10.1016/j.jvs.2018.03.275" @default.
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