Background and aims The anesthesia literature remains sparse regarding influence of primary anesthesia type with adverse events following minimally invasive transcarotid artery revascularization (TCAR). the objective was to report the association of primary anesthesia type with 30-day adverse events following TCAR.

Methods The Carotid Artery Stent – Targeted Participant User File was merged with American College of Surgeons National Surgical Quality Improvement Program registry from 2012 to 2016. the primary exposure was anesthesia type (regional/MAC versus general anesthesia). Primary endpoint was 30-day mortality. Secondary 30-day endpoints included pulmonary, renal, and cardiac complications, sepsis, DVT, stroke, transfusion, thrombosis of ipsilateral carotid vessel, reoperation. Logistic regression was used to evaluate the association of anesthesia type with adverse events. as patients are not identifiable, this study was exempt from approval by our institutional review board (UCSD IRB).

Results Final analysis included 625 patients. the prevalence of regional anesthesia/MAC was 73.4%. We observed a 93% decrease in the odds of 30-day mortality (p=0.003) in patients who received regional anesthesia/MAC. Mean [SD] hospital stay (2.99 [5.92] days versus 4.30 [9.15] days, p=0.037) and case duration (88.45 [39.48] minutes versus 105.85 [63.77] minutes, p<0.001) were shorter among patients who received regional anesthesia/MAC. Pulmonary complications (OR: 0.19 95% CI: 0.05 - 0.65, p=0.009) were lower in the regional/MAC group.

Conclusions The majority of studies on this topic pertain to carotid endarterectomy patients, this analysis sheds light on outcomes following TCAR. Overall, we urge further risk stratification and pre-procedural optimization to carefully select patients who may undergo regional/MAC.