• Issam Koleilat, John Denesopolis, Michael Parides, Katherine P MacCallum, and Evan Lipsitz.
• Department of Surgery, Community Medical Center, RWJ/Barnabas Health, Tom's River, NJ.. Electronic address: ikoleilat@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 1; 38 (10): 236223672362-2367.

ObjectivesCarotid artery stenting (CAS) may be performed by transfemoral or transcervical (TCAR) approaches and with a variety of anesthetic techniques. No current literature clearly supports one anesthetic method over another. We therefore sought to evaluate the outcomes of CAS procedures based on anesthetic approach.DesignRetrospective cohort study.SettingAmerican College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2018.ParticipantsAll individuals undergoing CAS during the study period.InterventionsAnesthetic type (locoregional versus general [GA]).Measurements And Main ResultsLocoregional anesthesia for CAS was used for 754 (65.5%) patients, with the remainder under GA. Demographic variables were comparable, as were the incidence of symptomatic presentation, high-risk anatomy or physiology, severity of the stenosis, and presence/severity of contralateral carotid disease. There was no difference in composite outcome (stroke, myocardial infarction [MI], and death) (7.0% v 6.1%, p = 0.53). The GA group had lower odds ratio of MI (0.12, p = 0.0362) but higher odds ratio of death (3.33, p = 0.008) and postoperative pneumonia (3.87, p = 0.0083), although on multivariable analysis the risk of death appeared confounded by respiratory variables. Multivariable and propensity score-weighted analyses did not identify a significant association of GA with the composite outcome.ConclusionsIn patients undergoing CAS in the National Surgical Quality Improvement Program, GA was not associated with the composite outcome but was associated with increased rates of postoperative pneumonia and decreased rates of MI. Further investigation should attempt to better clarify these relationships.Copyright © 2024 Elsevier Inc. All rights reserved.

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