Сhoice of Anaesthesia for Carotid Endarterectomy in the Acute Period of Ischemic Stroke

The aim of the study To determine the role of regional anesthesia in carotid endarterectomy in the acute period of ischemic stroke.

Material and methods. The world literature on the comparison of regional and general anesthesia in carotid endarterectomy has been studied and analyzed. The analysis also included the main randomized clinical trials and meta-analyses on this topic over the past 16 years. However, most of the articles are retrospective and from a single center.

Results. It was found that all the researches were devoted to comparing these two methods of anesthesia for planned carotid endarterectomy. Large meta-analyses, which included randomized trials, did not reveal significant differences between these two types of anesthesia according to the main results (transient ischemic attack, stroke, myocardial infarction and mortality). We have not found randomized clinical trials comparing regional and general anesthesia for carotid endarterectomy in the acute period of ischemic stroke (28 days). In this regard, a single-center prospective randomized clinical trial “Regional or general anesthesia for carotid endarterectomy in patients in the acute stage of ischemic stroke” was planned and registered in The ClinicalTrials.gov (Unique protocol ID: NCT06175715). General anesthesia means total intravenous anesthesia. The research was approved by the local ethics committee of the Federal State Budgetary Educational Institution of the Russian National Research University named after N.I. Pirogov of the Ministry of Health of the Russian Federation (extract from the minutes of the meeting of the LEK of the Russian National Research University named after N.I. Pirogov No. 223 dated October 23, 2023). The main endpoints of the study are: repeated ipsilateral stroke, any other stroke, big hemorrhagic complications that required surgical revision of the surgical wound or transfusion of blood components, fatal outcome and a combination of major adverse cardiovascular events (stroke + myocardial infarction + fatal outcome). The preliminary deadline for completing the study is December 2026.

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