Intraoperative Monitoring Modalities for Carotid Endarterectomy Under General Anaesthesia

Stroke is the most significant perioperative risk for patients undergoing carotid endarterectomy (CEA). Patients are accepting a greatly increased short-term risk of stroke in return for a reduced risk over the subsequent years. The causes of perioperative stroke are multiple and include emboli, technical problems such as intimal flap, intraoperative cerebral ischaemia during clamping, and postoperative hyperaemia. Despite a large number of clinical studies over many decades, no particular intervention has been shown to reduce the risk of perioperative stroke.1,2 Due to the low rate of perioperative stroke (overall risk <3%) and the multiple different causes, very large trials would be needed to detect a benefit from any particular monitoring technique.