The Role and Importance of Regional Anaesthesia Versus General Anaesthesia in Carotid Endarterectomy

Aim: To compare clinical outcomes, complication rates, and hospital resource use among patients undergoing carotid endarterectomy (CEA) under general anaesthesia (GA) or regional/local anaesthesia (RA) at a single tertiary vascular surgery centre.Material and Methods: We conducted a retrospective analysis of 102 consecutive CEA patients, with 60 receiving GA and 42 receiving RA. The primary endpoint was the occurrence of stroke, TIA, myocardial infarction (MI), or death within 30 days. Secondary endpoints included individual event rates, ICU and hospital stay duration, operative metrics, and complication rates. Multivariable logistic regression was used to identify predictors of prolonged ICU stay (>12 hours).Results: The groups had similar baseline clinical and demographic characteristics. The composite 30-day endpoint showed no significant difference between GA and RA patients (5.0% vs. 4.8%; p=1.000), with no significant differences in stroke (5.0% vs. 2.4%; p=0.641), 30-day mortality (3.3% vs. 0%; p=0.511), or any surgical complication. The notable difference was in ICU length of stay, which was significantly longer for GA patients (median 17 h [IQR 16–19] vs. 3 h [IQR 3–16]; p<0.001). In the multivariable regression, GA was the only independent predictor of prolonged ICU stay (OR=30.81, 95% CI 8.26–114.92; p<0.001).Conclusion: Regional anaesthesia offers a safety profile comparable to GA in CEA, with similar rates of neurological and cardiac complications. GA independently predicts longer ICU stays, suggesting that RA can provide significant benefits in hospital resource use without compromising clinical outcomes.