{
  "abstract": "Introduction Carotid artery stenting (CAS) is commonly performed under either general anesthesia (GA) or local/locoregional anesthesia (non-GA). Although GA may provide airway control and procedural stability, it may negate the minimally invasive advantages of CAS by increasing cardiopulmonary stress. Existing studies report conflicting results regarding the impact of anesthetic modality on perioperative outcomes. We performed a systematic review and meta-analysis to evaluate the association between anesthetic technique and early clinical outcomes following CAS.Methods A systematic search of MEDLINE, Embase, and Cochrane databases was conducted for comparative studies evaluating GA versus non-GA anesthesia in transfemoral CAS. Observational cohort studies reporting early (in-hospital or 30-day) outcomes were included. The primary outcome was all-cause perioperative mortality. Secondary outcomes included stroke, myocardial infarction (MI), and major adverse cardiovascular events (MACE). Random-effects meta-analysis was performed using the Hartung-Knapp-Sidik-Jonkman method with restricted maximum likelihood estimation. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using I 2 statistics.Results Three multicenter observational studies comprising 15,730 patients (GA: 2,641; non-GA: 12,089) were included. GA was associated with significantly higher perioperative mortality compared with non-GA anesthesia (OR 3.57, 95% CI 2.10-6.06; I 2=0%). No significant difference was observed in stroke (OR 1.33, 95% CI 0.39-4.55; I2=29%) or MI (OR 0.83, 95% CI 0.02-41.91; I2=71%). MACE did not differ significantly between groups (OR 1.67, 95% CI 0.47-5.97; I2=76%), though heterogeneity was substantial and composite definitions varied across studies. Event rates were low overall, and estimates for MI and MACE were imprecise due to sparse events.Conclusion In this meta-analysis of contemporary observational data, general anesthesia was associated with significantly increased perioperative mortality following carotid artery stenting. No significant differences were observed in stroke or myocardial infarction; however, these estimates were limited by heterogeneity and low event rates. These findings suggest that anesthetic selection may influence early mortality after CAS and warrant further prospective evaluation to clarify causality and optimize patient selection.Disclosures W. Lee: None. W. Luo: None. T. QM Tran: None. R. Correia Maciel: None. E. Raz: None. A. Dmytriw: None. S. Sheth: None. M. Nahhas: None. R. Regenhardt: None. P. Chen: None.Abstract E-302 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, SUNY Downstate Health Sciences University, New York City, NY"
      ],
      "name": "W Lee"
    },
    {
      "affiliations": [
        "Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ"
      ],
      "name": "W Luo"
    },
    {
      "affiliations": [
        "Department of Medicine, Washington University School of Medicine, St. Louis, MO"
      ],
      "name": "T QM Tran"
    },
    {
      "affiliations": [
        "Jundiaí Medical School, São Paulo, Brazil"
      ],
      "name": "R Correia Maciel"
    },
    {
      "affiliations": [
        "Department of Radiology and Neurosurgery, NYU Langone, New York City, NY"
      ],
      "name": "E Raz"
    },
    {
      "affiliations": [
        "Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD"
      ],
      "name": "V Yedavalli"
    },
    {
      "affiliations": [
        "Neuroradiology, Henri Mondor Hospital, Paris, France"
      ],
      "name": "L Scarcia"
    },
    {
      "affiliations": [
        "School of Medicine, Toronto Metropolitan University, Toronto, ON, Canada",
        "Nuffield Department of Surgical Sciences Medical Sciences Division, University of Oxford, Oxford, United Kingdom"
      ],
      "name": "A Dmytriw"
    },
    {
      "affiliations": [
        "Division of Vascular and Interventional Neurology, University of Houston Health Science Center, Houston, TX"
      ],
      "name": "S Sheth"
    },
    {
      "affiliations": [
        "Division of Vascular and Interventional Neurology, University of Houston Health Science Center, Houston, TX"
      ],
      "name": "M Nahhas"
    },
    {
      "affiliations": [
        "Division of Vascular and Interventional Neurology, University of Houston Health Science Center, Houston, TX"
      ],
      "name": "R Regenhardt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Houston Health Science Center, Houston, TX"
      ],
      "name": "P Chen"
    }
  ],
  "title": "E-302 Impact of anesthetic modality on clinical outcomes after carotid artery stenting: a systematic review and meta-analysis",
  "uid": "f5664300-efd7-5661-a20f-b5fb871a785a"
}