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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Thomas S. D. 1, 2, Norman P. E. 2, Temple S. E. L. 3, Vijayan V. 1, Mwipatayi B. P. 1, 2
1 Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia;
2 School of Surgery, University of Western Australia, Perth, Western Australia;
3 School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia
AIM: The results of the GALA (general anaesthesia [GA] versus local anaesthesia [LA] in Carotid Surgery) trial demonstrated no significant differences between the two methods of anesthesia. Variation in surgical and anaesthetic practices amongst the trial centers was not accounted for and differences may have influenced outcomes. The aim of this study was to report the West Australian experience of GA versus LA for carotid artery endarterectomy (CEA) with particular attention to an analysis of sonographic follow-up to determine disease progression.
METHODS: The methods followed the GALA trial protocol as published previously. We analyzed the results for all patients entered into the trial from Western Australia. Duplex ultrasound of the ipsilateral and contralateral carotid arteries was performed at one month and one-year post procedure to determine if there was progression of the disease.
RESULTS: All eighty patients undergoing CEA were analyzed in this study, of which 47 had been randomized to the GA group and 33 to the LA group. Six patients from the GA group and one patient from the LA group crossed over to the other group. There were no significant differences in patient baseline characteristics, use of patch angioplasty or shunts. There were no statistically significant differences in the primary outcomes (stroke of any type, myocardial infarction or death) at discharge or at one month follow up between the two groups. On sonographic follow-up, there was a trend towards more severe ipsilateral restenosis in the LA group compared to the GA group but this did not achieve statistical significance.
CONCLUSION: The Western Australian experience of GA versus LA in CEA suggests no significant difference in outcome between the two groups. This finding demonstrates that the GALA trial results are replicable in individual centers despite variations in practices. Sonographic follow-up suggests that the restenosis rate was similar for both groups with similar disease progression in contralateral carotids. Restenosis and contralateral disease progression occur and should be monitored via duplex scan.