• Amer Harky, Jeffrey Shi Kai Chan, Thompson Ka Ming Kot, Dilan Sanli, Rashad Rahimli, Zlatka Belamaric, Marcus Ng, Ian Yu Young Kwan, Christiana Bithas, Ragai Makar, Ramasubramanyan Chandrasekar, and Sameh Dimitri.
• Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom. Electronic address: aaharky@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2020 Jan 1; 34 (1): 219-234.

ObjectiveThe choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local anesthesia (LA) in CEA.DesignSystematic review and meta-analysis of comparative studies.SettingHospitals.ParticipantsAdult patients undergoing CEA with either LA or GA.InterventionsThe effects of GA and LA on CEA outcomes were compared.Measurements And Main ResultsPubMed, OVID, Scopus, and Embase were searched to June 2018. Thirty-one studies with 152,376 patients were analyzed. A random effect model was used, and heterogeneity was assessed with the I2 and chi-square tests. LA was associated with shorter surgical time (weighted mean difference -9.15 min [-15.55 to -2.75]; p = 0.005) and less stroke (odds ratio [OR] 0.76 [0.62-0.92]; p = 0.006), cardiac complications (OR 0.59 [0.47-0.73]; p < 0.00001), and in-hospital mortality (OR 0.72 [0.59-0.90]; p = 0.003). Transient neurologic deficit rates were similar (OR 0.69 [0.46-1.04]; p = 0.07). Heterogeneity was significant for surgical time (I2 = 0.99, chi-square = 1,336.04; p < 0.00001), transient neurologic deficit (I2 = 0.41, chi-square = 28.81; p = 0.04), and cardiac complications (I2 = 0.42, chi-square = 43.32; p = 0.01) but not for stroke (I2 = 0.22, chi-square = 30.72; p = 0.16) and mortality (I2 = 0.00, chi-square = 21.69; p = 0.65). Randomized controlled trial subgroup analysis was performed, and all the aforementioned variables were not significantly different or heterogenous.ConclusionThe results from this study showed no inferiority of using LA to GA in patients undergoing CEA. Future investigations should be reported more systematically, preferably with randomization or propensity-matched analysis, and thus registries will facilitate investigation of this subject. Anesthetic choice in CEA should be individualized and encouraged where applicable.Copyright © 2019 Elsevier Inc. All rights reserved.

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