Abstract
Background: We perform carotid artery stenting (CAS) under selective general anesthesia for high-risk patients, e.g., those with hemodynamic compromise or contralateral carotid artery obstruction, in order to stabilize the hemodynamics and control body movement. Objective: To conduct a retrospective analysis of the safety of CAS under selective general anesthesia. Methods: CAS for carotid artery stenosis was performed in 22 patients (20 men, 2 women; mean age 70±7 years, 24 procedures) between July 2010 and October 2014 at our institute. These patients were assigned to local and general anesthesia groups primarily on the basis of intracranial hemodynamic considerations or systemic complications. Local anesthesia was used for 11 procedures and general anesthesia for 13. In the general anesthesia group, patients were administered propofol and those with hemodynamic compromise were preoperatively given a free radical scavenger (Edaravone); general anesthesia was continued for a few days after CAS in an intensive care unit. Patients: In the local anesthesia group, 6 patients had ischemic heart disease, 2 patients had no appreciable risk factor, and the others had contralateral carotid artery obstruction, radiation-induced carotid artery stenosis, or hemodynamic compromise. In the general anesthesia group, 5 patients had hemodynamic compromise, 2 patients had contralateral carotid artery obstruction, 3 patients had radiation-induced carotid artery stenosis, one patient had carotid artery stenosis with vulnerable plaque and one had intracranial cerebral aneurysm. Results: Technical and periprocedural angiographic success was achieved in 100% of the patients. Five cases (38%) showed new lesions in MRI-DWI after CAS in the general anesthesia group, compared with three cases (27.7%) in the local anesthesia group; however, the difference is not statistically significant. In the local anesthesia group, one patient with hemodynamic compromise suffered severe disability due to intracranial hemorrhage immediately after CAS, and another had retinal artery occlusion. In the general anesthesia group, there was no neurological disability and no procedure-related complication, even though these were high-risk patients. Conclusion: Carotid artery stenting under selective general anesthesia for CAS in high-risk patients appears to be safe.
