Carotid Endarterectomy Under Local Anaesthesia does not Increase Plasma Homocysteine Concentration

The purpose of this cohort study was to evaluate the effect of carotid endarterectomy under local anaesthesia on homocysteine (Hcy) concentrations. Of 100 patients with internal carotid artery (ICA) stenosis >70%, the complete data set was available for 91 patients (39 asymptomatic and 52 symptomatic). All patients underwent eversion endarterectomy of the ICA under regional anaesthesia. Thirty-two percent of the examined patients had a total Hcy above 15μmol/l. The mean Hcy levels preoperatively were 13.9±4.8μmol/l. The Hcy levels on day 5 were 13.1±5.0μmol/l and after 6 months 14.0±5.8μmol/l. There was no significant change during follow-up. No intraoperative strokes and deaths were observed and during the 6 months follow-up no recurrent strokes, TIAs or deaths occurred. Patients undergoing carotid endarterectomy under regional anaesthesia do not have an increase in total Hcy postoperatively. This finding is in contrast to results from cardiac surgery and carotid endarterectomy in a recently published animal study, both performing surgery under general anaesthesia.