Y a-t-il quelque chose de changé dans la prise en charge du patient opéré de la carotide ? (podcast)

Owing to the lower risk of stroke in patients receiving an adapted medical treatment, the indications of carotid surgery have been recently reviewed. It is recommended to consider surgery for symptomatic carotid stenosis ≥ 50 % and ≥ 70 % asymptomatic stenosis. To reduce the risk of recurrence, symptomatic patients should be scheduled for surgery within the two weeks after stroke. In Europe, endarterectomy remains gold standard while carotid stenting is considered as an alternative. The anaesthetic management of the high cardiovascular risk patients should ensure adequate intraoperative cerebral perfusion and prevent the occurrence of myocardial ischemia. The choice of general or regional anaesthesia remains at the discretion of the anaesthetist in collaboration with the surgeon. The use of target-controlled intravenous anaesthesia is real advance in carotid surgery allowing haemodynamic stability and rapid recovery. Regional anaesthesia has been simplified, superficial cervical block being sufficient to provide adequate perioperative analgesia, with only few or no complications. Cerebral monitoring is critical in detecting brain ischemia and guiding the surgical procedure. Among the available monitoring devices, near-infrared spectroscopy is a promising technique ongoing validation.