Anaesthesia for carotid endarterectomy

Cerebrovascular disease is a major public health problem in the Western world. Carotid endarterectomy reduces the risk of stroke in patients with symptomatic carotid stenosis, but itself is associated with appreciable morbidity and mortality. Careful patient selection is therefore necessary, and this is informed by several large multi-centre trials. The relevant anatomy and pathology are first outlined below with a description of the basic surgical technique. The relative merits of general and regional anaesthesia are discussed, with particular emphasis on detailed pre-operative assessment. The role of various cerebral monitoring techniques is explored together with the common and serious complications that may be encountered in the perioperative period.