Non-General Anesthesia Linked to Improved Outcomes in Carotid Artery Stenting

Introduction/Purpose The optimal anesthesia approach during carotid artery stenting (CAS) remains debated, with limited large‐scale evidence comparing general and non‐general anesthesia strategies. This study aimed to evaluate peri‐procedural characteristics, functional outcomes, and mortality risk associated with anesthesia modality in patients undergoing CAS. Materials/Methods We analyzed 888 patients undergoing CAS, stratified by anesthesia modality: general anesthesia (n = 222) and non‐general anesthesia, including monitored anesthesia care/conscious sedation (n = 666). The primary outcome was a composite of 30‐day periprocedural mortality, postoperative ischemic or hemorrhagic stroke, and myocardial infarction. Secondary outcomes included access site complications, in‐stent thrombosis, dissection, hemodynamic instability, and 90‐day modified Rankin Scale score. Logistic regression was used to assess associations between anesthesia type and the study outcomes. Odds ratios (OR) with 95% confidence intervals (CI) were reported. Statistical significance was defined as p < .05. Results At 30 days, functional outcomes were significantly more favorable among patients receiving non‐general anesthesia (modified Rankin Scale: Mean = 0.98, SD = 1.46 vs. Mean = 1.56, SD = 1.93; p < .001). Procedure‐related mortality was higher in the general anesthesia group (2.3% vs. 0.3%; p = .016), whereas non‐procedure‐related mortality rates were similar (1.8% vs. 1.4%; p = .872). Rates of ischemic stroke, hemorrhagic stroke, asymptomatic intracranial hemorrhage, myocardial infarction, and other peri‐procedural complications were low (<2%) and did not differ significantly by anesthesia type. Regression analysis demonstrated that non‐general anesthesia was independently associated with reduced odds of the primary outcome (OR = 0.27, 95% CI [0.08, 0.90], p = .033), all‐cause mortality (OR = 0.40, 95% CI [0.16, 0.97], and 30‐day procedure‐related mortality (OR = 0.13, 95% CI [0.03, 0.68], p = .010). Conclusion Non‐general anesthesia during carotid artery stenting was associated with improved functional outcomes and reduced 30‐day mortality compared with general anesthesia. These findings suggest that non‐general anesthesia, particularly monitored anesthesia care, may represent a safer approach in the peri‐procedural management of patients undergoing CAS.