Department of Neurosurgery, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic.
Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Ostrava, Ostrava, Czech Republic.
J Vasc Surg. 2019 Jul;70(1):138-147. doi: 10.1016/j.jvs.2018.10.066. Epub 2019 Feb 18.
Silent and symptomatic cerebral infarctions occur in up to 34% of patients after carotid endarterectomy (CEA). This prospective study compared the risk of new brain infarctions detected by magnetic resonance imaging (MRI) in patients with internal carotid artery stenosis undergoing CEA with local anesthesia (LA) vs general anesthesia (GA).
Consecutive patients with internal carotid artery stenosis indicated for CEA were screened at two centers. Patients without contraindication to LA or GA were randomly allocated to the LA or GA group by ZIP code randomization. Brain MRI was performed before and 24 hours after CEA. Neurologic examination was performed before and 24 hours and 30 days after surgery. The occurrence of new infarctions on the control magnetic resonance images, stroke, transient ischemic attack, and other complications was statistically evaluated.
Of 210 randomized patients, 105 underwent CEA with LA (67 men; mean age, 68.3 ± 8.1 years) and 105 with GA (70 men; mean age, 63.4 ± 7.5 years). New infarctions were more frequently detected on control magnetic resonance images in patients after CEA under GA compared with LA (17.1% vs 6.7%; P = .031). Stroke or transient ischemic attack occurred within 30 days of CEA in three patients under GA and in two under LA (P = 1.000). There were no significant differences between the two types of anesthesia in terms of the occurrence of other complications (14.3% for GA and 21.0% for LA; P = .277).
The risk of silent brain infarction after CEA as detected by MRI is higher under GA than under LA.
在颈动脉内膜切除术（CEA）后，多达 34%的患者会出现无症状性和症状性脑梗死。本前瞻性研究比较了在局部麻醉（LA）与全身麻醉（GA）下接受 CEA 的颈内动脉狭窄患者中，通过磁共振成像（MRI）检测到新脑梗死的风险。
在两个中心筛选出有颈内动脉狭窄并适合行 CEA 的连续患者。无 LA 或 GA 禁忌证的患者通过 ZIP 码随机分配至 LA 或 GA 组。在 CEA 前和术后 24 小时进行脑 MRI。在术前、术后 24 小时和 30 天时进行神经检查。对对照磁共振图像上的新发梗死、卒中和短暂性脑缺血发作以及其他并发症的发生进行统计学评估。
在 210 例随机患者中，105 例行 LA 下 CEA（67 例男性；平均年龄 68.3 ± 8.1 岁），105 例行 GA 下 CEA（70 例男性；平均年龄 63.4 ± 7.5 岁）。与 LA 相比，GA 下 CEA 术后患者的对照磁共振图像上更频繁地检测到新发梗死（17.1%比 6.7%；P =.031）。在 GA 下 CEA 后 30 天内有 3 例患者发生卒中和短暂性脑缺血发作，而 LA 下有 2 例患者（P = 1.000）。两种麻醉类型在其他并发症的发生方面无显著差异（GA 组为 14.3%，LA 组为 21.0%；P =.277）。
与 LA 相比，GA 下 MRI 检测到的 CEA 后无症状性脑梗死风险更高。
