Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.

Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.

World Neurosurg. 2015 Dec 24;

Authors: Dellaretti M, Dourado J, de Souza RF, Fontoura RR, de Sousa AA

Abstract
OBJECT: During CEA, carotid cross-clamping is performed to allow for artery incision and plaque removal. There is a very small subgroup of patients who can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurological deficit. These patients are described as having "cross-clamp intolerance". The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition.
METHODS: From August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to ICA occlusion for less than 30 s were considered to have cross-clamp intolerance.
RESULTS: Among the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in less than 30 s, i.e. these patients presented cross-clamp intolerance. The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion.
CONCLUSION: Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion.

PMID: 26724635 [PubMed – as supplied by publisher]

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