Local Anesthesia and Enhanced Recovery after Transcarotid Artery Revascularization

Transcarotid artery revascularization (TCAR) is a minimally invasive surgical treatment for carotid artery stenosis. This study describes a 10-year institutional experience of TCAR and the concurrent development of enhanced recovery protocols. Standardized practices were implemented at a single institution for patients undergoing TCAR. This included protocolized preoperative imaging and medical optimization, intraoperative workflow, and postoperative care. Additionally, vascular anesthesiology protocols were established for managing local and general anesthesia. A retrospective review of patients undergoing TCAR was subsequently conducted. Data on patient demographics, procedural details, and outcomes were analyzed from a prospectively maintained institutional database. Across 321 patients, the median hospital stay after TCAR was 1.0 days with low-postoperative complications, most notably a 1.9% perioperative stroke-death rate. Multidisciplinary collaboration is necessary to develop sustainable and effective enhanced recovery protocols. Implementation of these care pathways can improve patient outcomes and efficiency of care.