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Anaesthesia for carotid endarterectomy

Carotid arterial atherosclerosis is a common cause of stroke. The internal carotid artery and the carotid bifurcation are the locations most frequently affected by carotid atherosclerosis. Carotid endarterectomy (CEA) is an established revascularization intervention that removes atherosclerotic plaque. In this algorithm, we will review the anaesthetic management of an elderly patient undergoing CEA, utilizing two possible options.

Author: Veronika Tomaskova MD, Richard Bašista, Ondrej Bilec

Institution: Faculty of Medicine at Masaryk University in Brno

Medical discipline: Emergency Medicine

Keywords: atherosclerosis ACC | endarterectomy (CEA) | general anaesthesia vs local anaesthesia | complications of CEA | importance of neuromonitoring | postoperative cognitive dysfunction in patient

Educational evel: Undergraduate level | Graduate

Carotid arterial atherosclerosis is a common cause of stroke. The internal carotid artery and the carotid bifurcation are the locations most frequently affected by carotid atherosclerosis. Carotid endarterectomy (CEA) is an established revascularization intervention that removes atherosclerotic plaque. In this algorithm, we will review the anaesthetic management of an elderly patient undergoing CEA, utilizing two possible options.


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Review

Carotic endarterectomy is one of a few curative (operative) procedures that allows to significantly reduce the risk of an ischemic stroke. During the procedure, it is necessary to temporarily interrupt the blood flow in the impaired carotid artery. If the blood flow trough the collateral circulation of the circle of Willis is insufficient, it could lead to the development of brain ischemia. As a result the question of appropriate anaesthesia and monitoring of the patient during surgery is a subject of long-lasting discussions and disputes. This algorithm presents the essentials in the decision-making process whilst taking care of a patient undergoing CEA in a very simple and educative way including the response to possible complications.

publikováno: 22.5.2019 | last modified on: 19.12.2019