Anesthesia for Carotid Artery Surgery

Abstract

The only real indication for cartoid endarterectomy (CE) is to reduce the risk of future cerebral infarction. If the stroke rate from surgery approaches the incidence of stroke in the natural history of the disease, there is no benefit to the patient. Whereas it is widely held that the majority of ischemic events associated with CE are thromboembolic in origin, the preponderance of literature is aimed at diminishing the risk of stroke from low flow induced by carotid clamping during surgery. Despite this paradox, countless clinical studies exist which are contradictory as to necessity and best means of affecting cerebral protection by the use of intraoperative monitoring and internal shunts.