Carotid endarterectomy is an operation that removes hardened plaque from the carotid artery that narrows the lumen of the artery, restoring blood flow. With age, the plaque grows in the artery wall. As the plaque grows, the lumen of the artery narrows, which in turn leads to reduced blood flow through the carotid arteries [1,2].

A stroke occurs when blood stops flowing to any part of the brain and the carotid artery is the main blood vessel that supplies blood to the brain. This artery can narrow due to fatty deposits that build up over time. One in five strokes is caused by narrowing of the carotid artery. Blood clots can form at the site of the stenosis. If the blood clot breaks off and travels through the blood, it can travel to the brain, where it blocks the blood supply and causes a stroke [3-5].

Surgery known as a carotid endarterectomy removes the inner lining, fatty deposits and blood clots from the carotid artery and reduces the risk of stroke. However, even with very delicate surgery, 1 in 20 people will have a stroke caused by the surgery itself [6,7].

Current evidence does not show clear differences between local anesthesia (where the patient remains awake) and general anesthesia in terms of the risk of stroke, death, or other unwanted effects in people who have had surgery to widen a narrowed carotid artery (carotid endarterectomy) [8].

We searched for studies comparing local and general anesthesia in people undergoing carotid endarterectomy. Results were compared and summarized and confidence in the evidence was assessed based on factors such as methodology and study sizes [9,10].

Sixteen studies were found with 4,839 people. The largest study involved 3,526 people and the 20 smallest studies were conducted worldwide. More men than women were included in the studies and the average age was 67 years [11].

Local anesthesia does not make a significant difference in the risk of stroke 30 days after surgery compared  to  general  anesthesia.  Local  anesthesia may  not  reduce  the  risk  of  death  30 days after surgery compared to general anesthesia. Since either type   of   anesthesia   has   clear   advantages  over  the other, any A type of anesthesia based on the clinical situation and the preferences of the surgeon and patient [12,13].

Carotid endarterectomy is one of the most common vascular procedures performed. In appropriately selected patients, carotid endarterectomy has been shown to reduce the relative risk of stroke by 50%, compared to medical treatment alone. Achieving it constitutes a twofold challenge: first, the challenge that stems from the specificity of this surgical intervention, which requires carotid artery impingement and its consequences and later, the challenge related to the polyvascular condition in general for these patients; therefore, it is essential to prevent double morbidity and mortality, both neurological and cardiac, for this intervention. Carotid endarterectomy is traditionally performed under general anesthesia, but a cervical plexus block is increasingly being used in this surgical procedure and cervical epidural or wakefulness sedation is also used. Currently, several studies recommend local anesthesia, as it appears to reduce morbidity and mortality and allows for simple and continuous monitoring of the brain. Postoperative complications must be detected quickly before urgent treatment can be applied [14-16].

With age, plaque forms in the blood vessels. In addition, arteries and veins lose their elasticity. The result is narrowing of the bloodstream and associated high blood pressure and circulatory disorders. Large vessels, such as the carotid arteries, can also be affected by plaque and narrow as a result. At this point, the brain is not adequately supplied with blood. In the best cases, the performance of the brain deteriorates. In the worst cases, severe neurological symptoms occur, or the debris loosens and blocks a blood vessel in the brain [17,18].

In the case of severe narrowing of the carotid arteries by more than 70% or neurological problems, the vessels are dilated again during the operation. To date, this procedure has been performed on one of the most important human blood vessels under general anesthesia [19,20].

Patient Sample

One hundred seventy patients were collected from Kirkuk General Hospital, Kirkuk, Iraq.

Patients who did not know the anesthesia technique that was relied on were excluded.

The study aimed at a retrospective analysis of patients who underwent endarterectomy by relying on the statistical analysis program SPSS SOFT 22.0.

Study Design 

Information and demographic data were collected from age, gender, in addition to the presence of patient-related diseases, coronary artery disease, peripheral arterial disease; in addition, a comparative study was conducted on the awake patient under anesthesia and anesthesia with regard to complications that occur after surgery, stroke, myocardial infarction ~ and death. Perinatal stroke was defined as any new neurological deficit that appeared in the perineal period and the EEG and EEG were not routinely relied upon in neuromonitoring. 

Coronary patients in the study were identified as having any history of myocardial infarction and coronary artery disease.

Study Period 

As mentioned previously, data and information were collected from Kirkuk General Hospital, as mentioned previously and the study period was in 1 year, from 22-3-2017 to 3-6-2018.

Aim of Study 

The research aims to conduct a comparative study between the types of anesthesia for patients with carotid endarterectomy.

Information and data on the neurological status of patients were collected before surgery, as shown in the Table 4.

Two hundred patients were collected from a hospital and all  demographic  information  and  patient  data  were analyzed. Patients who underwent only general and local anesthesia were identified. Patients were divided into 100 general anesthesia patients and 100 patients who underwent local anesthesia.

Table 1: Distribution of results according to age

A: Multiple modes exist, The smallest value is shown

Table 2: Characteristics of patients GA

Table 3: Characteristics of patients LA

Table 4: Neurological status of GA

Table 5: Neurological status of LA

Table 6: Final results of patients according to GA 

Table 7: Final results of patients according to LA 

Table 8: CI (prevalence 95%) of results according to type of anesthesia

Table 9: p-value of results 

The statistical analysis program SPSS soft was also used to find mean value and STD. division to the ages of patients, where the ages of patients for general anesthesia were 61.7±2.89, as for the ages of patients who underwent local anesthesia 60.7±3.07 as shown in Table 1.

The characteristics of patients who underwent carotid artery resection with respect to local and general anesthesia were also identified, where arterial hypertension was found in 28% and coronary heart disease in 20% For patients with general anesthesia, the percentage and differences were somewhat different in local anesthesia, where arterial hypertension was 17%, as shown in Table 3.

No significant differences were found between the ALR and GA groups with regard to postoperative complications and we found a mortality rate of 0.6 vs. 1%, similar to that described in the study

General Anesthesia (RA) is the gold standard for neurological monitoring during carotid endarterectomy (CEA), as the data and results of our study show that providing general anesthesia is associated with fewer complications after surgery by identifying the statistical differences in results.

By reviewing the medical records in the hospital, the values ​​of blood pressure were identified, where the Systolic Blood Pressure (SBP) was <100 mmHg, while for the high blood pressure, it was defined as >160

When performing anesthesia, it is also important to significantly reduce the severity of the autonomic (spontaneous) reactions of the body to surgical trauma, which are manifested by an increase in heart rate (tachycardia), hypertension and other phenomena that may occur.

Through the retrospective study of the information and demographic data in the hospital, it was concluded that general anesthesia is a better method during surgery in order to reduce the complications that occur later. In addition, simple statistical differences were found between the types of anesthesia.

Recommendation for Solve Problem

• Angioplasty and internal carotid artery stenting is a minimally invasive, high-tech vascular intervention performed under local anesthesia

• If for any reason a stenosis develops within the carotid artery, the blood flow is disturbed, which can lead to the formation of blood clots (blood clots) that can cause an accident in the cerebral blood vessels. The greater the degree of stenosis of the carotid artery, the greater the risk of stroke

• If don't need surgery, your doctor may recommend lifestyle changes (controlling your blood pressure, quitting smoking, eating healthy and getting regular physical activity) to reduce your risk of stroke. It may be prescribed drugs that thin the blood, improve blood flow in the brain, restore the function of nerve cells and also prevent the development of atherosclerosis

• The process takes an average of 1.5-2 hours; It is performed under general anesthesia; it is recommended to spend the night before the operation in the hospital. Bring toiletries, slippers and a bathrobe. On the morning of surgery, remove all foreign objects, including chains, bracelets, rings, earrings and watches and remove any removable dentures

• Using local anesthesia, only the place where the surgical intervention is performed is anesthetized, but the patient himself remains conscious

• During the operation, under local anesthesia, sedatives (sedatives) can be administered, thanks to which the patient can lie quietly without worrying during the entire intervention

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