An approach to carotid endarterectomy surgery that uses local instead of general anesthesia can better manage cardiac issues and thus result in fewer future complications.

“MUSC has a long history of managing carotid artery disease and reducing stroke rates,” says Ravi Veeraswamy, M.D., chief of MUSC’s Division of Vascular Surgery.

“We're continuing that tradition now with advancements, one of which is performing carotid surgery under a local anesthetic, so a patient never needs to be put to sleep.”

Awake Carotid Endarterectomy: Basics and Benefits

Carotid endarterectomy surgery can effectively remove plaque buildup due to carotid artery disease, or stenosis, with the ultimate goal of preventing future stroke. However, stroke is a significant complication concern of surgeons when performing this procedure—and it can be tough to identify when patients are under general anesthesia.

In an awake approach, patients receive a regional anesthesia block to numb the neck, so they are awake and comfortable for the entire procedure. Using regional in lieu of general anesthesia offers multiple benefits in managing stroke and other cardiac issues.

“One main benefit to this approach is that we know in real time if there is a problem with the patient having a stroke, and we can do something about it then,” says Dr. Veeraswamy. During a general anesthesia approach, surgeons must wait until the procedure is completed and the patient is awake to ascertain whether any stroke-related complications ensued.

“The local anesthesia approach also makes it easier to manage cardiac issues, because patients never have general anesthesia,” he adds.

Besides the anesthesia approach, little else of the carotid endarterectomy surgery is modified.
“We perform the procedure the exact same way as with general anesthesia,” says Dr. Veeraswamy. “It's just more streamlined, because we avoid general anesthesia.”

Outcomes for general versus local anesthesia approaches are equivalent, though Dr. Veeraswamy believes awake carotid has the potential for lower cardiac complication rates. “The rates of stroke or carotid-related complications are similar whether patients are under general or local anesthesia. However, we believe the rates of cardiac complications might be lower with the awake procedure. It certainly gives the referring physician, the surgeon, and the patient another great alternative to general anesthesia.”

Awake Carotid Endarterectomy: The Right Candidates

According to Dr. Veeraswamy, most patients appreciate the added option of choosing general versus local anesthesia for this surgery. Some are floored by this new capability.

“They're amazed that we can operate on their neck and literally be asking them about their family while we're doing it,” says Dr. Veeraswamy.

Still, he admits it’s not for everyone. Personal preference and certain health indications make some people poor candidates for this awake approach, including patients with:

  • Claustrophobia, or a fear of confined spaces. 
  • Anxiety or unease about the idea of being awake for a specialized operation.
  • Arthritis or other health issues that limit their neck movement.

“For these patients, we strongly consider carotid stent placement or carotid endarterectomy surgery under general anesthesia,” says Dr. Veeraswamy.

Carotid Artery Disease: A Tailored Treatment Approach

Dr. Veeraswamy says that this approach is part of MUSC’s greater focus on customizing patient treatment options to individual circumstances and preferences.

“We have the ability to tailor procedures for each patient,” he says. “We can do what's best for one patient, and that may be different than what we do for another patient, because MUSC offers so many options in how we treat patients.”

For more information, contact Dr. Veeraswamy at veeraswa@musc.edu.