Locoregional versus General Anesthesia for Carotid Artery Stenting in the ِAmerican College of Surgeons National Surgical Quality Improvement Project

Objectives Carotid artery stenting (CAS) may be performed by transfemoral (tfCAS) or transcervical (TCAR) approaches and with a variety of anesthetic techniques. No current literature clearly supports one anesthetic method over another. We therefore sought to evaluate the outcomes of CAS procedures based on anesthetic approach. Design Retrospective cohort study Setting American College of Surgeons National Surgical Quality Improvement Program database from 2011-2018 Participants All individuals undergoing CAS during the study period. Interventions Anesthetic type (locoregional [LRA] versus general [GA]). Measurements and Main Results LRA for CAS was employed for 754 (65.5%) patients with the remainder under GA. Demographic variables were comparable as was incidence of symptomatic presentation, high-risk anatomy or physiology, severity of the stenosis and presences/severity of contralateral carotid disease. There was no difference in composite outcome (stroke, myocardial infarction (MI) and death) (7.0% v 6.1%, p=0.53). The GA group had lower odds ratio (OR) of MI (0.12, p=0.0362) but higher OR of death (3.33, p=0.008) and postoperative pneumonia (3.87, p=0.0083), although on multivariable analysis the risk of death appeared confounded by respiratory variables. Multivariable and propensity score weighted analyses did not identify a significant association of GA with the composite outcome. Conclusions In patients undergoing CAS in the NSQIP, GA was not associated with the composite outcome but was associated with increased rates of postoperative pneumonia and decreased rates of MI. Further investigation should attempt to better clarify these relationships.