zabmedvestnikЗабайкальский медицинский вестникTransbaikalian Medical Bulletin1998-6173Читинская государственная медицинская академия10.52485/19986173_2026_2_100zabmedvestnik-573Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSВЫБОР АНЕСТЕЗИОЛОГИЧЕСКОГО ОБЕСПЕЧЕНИЯ (ОБЩАЯ ИЛИ РЕГИОНАРНАЯ АНЕСТЕЗИЯ) ДЛЯ КАРОТИДНОЙ ЭНДАРТЕРЭКТОМИИCHOICE OF ANESTHESIOLOGICAL CARE (GENERAL OR REGIONAL ANESTHESIA) FOR CAROTID ENDARTERECTOMYhttps://orcid.org/0000-0002-1115-609XКазанцевА. Н.KazantsevA. N.

Казанцев Антон Николаевич, военный врач, сердечно-сосудистый хирург

Иваново

Anton Nikolaevich Kazantsev, surgeon

Ivanovo

dr.antonio.kazantsev@mail.ruФГКУ «36 отдельный медицинский отряд (аэромобильный) воздушно-десантных войск» Министерства обороны Российской ФедерацииРоссия36th Independent (Aeromobile) Medical Detachment, Airborne Forces, Ministry of Defense of the Russian FederationRussian Federation20263007202602100117Copyright © Казанцев А.Н., 20262026Казанцев А.Н.Kazantsev A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zabmedvestnik.ru/jour/article/view/573

Каротидная эндартерэктомия (КЭАЭ) является «золотым стандартом» профилактики инсульта при гемодинамически значимом стенозе сонных артерий. Выбор метода анестезии — общей (ОА) или регионарной (РА) — остаётся предметом дискуссии, поскольку влияет на риск периоперационных осложнений.

Было проанализировано 78 источников, включая рандомизированные контролируемые исследования, проспективные и ретроспективные когорты, систематические обзоры и мета-анализы, опубликованные до 2026 года. Не выявлено разницы в частоте периоперационного инсульта между ОА и РА. Однако РА была ассоциирована со значимым снижением риска инфаркта миокарда, особенно у пациентов с сердечной недостаточностью. РА также коррелировала с меньшей продолжительностью операции и госпитализации, но с более частыми гемодинамическими колебаниями. Эффективность нейромониторинга (мультимодального при ОА и клинико- инструментального при РА) была ключевым фактором, определяющим неврологическую безопасность. Умеренная гипотермия показала потенциал в снижении послеоперационных когнитивных нарушений.

Таким образом, выбор между ОА и РА при КЭАЭ должен быть персонализированным, основанным на доминирующем профиле риска пациента.

Carotid endarterectomy (CEAE) is the "gold standard" for stroke prevention in patients with hemodynamically significant carotid artery stenosis. The choice of anesthesia method — general (OA) or regional (RA) — remains a matter of debate, as it affects the risk of perioperative complications. This article analyzed 78 sources, including randomized controlled trials, prospective and retrospective cohorts, systematic reviews, and meta-analyses published through 2026. There was no statistically significant difference in the incidence of perioperative stroke between OA and RA. However, RA was associated with a significant reduction in the risk of myocardial infarction, especially in patients with heart failure. RA also correlated with shorter duration of surgery and hospitalization, but with more frequent hemodynamic fluctuations. The effectiveness of neuromonitoring (multimodal in OA and clinico-instrumental in RA) was a key factor determining neurological safety. Moderate hypothermia has shown potential in reducing postoperative cognitive impairment. Thus, the choice between OA and RA in CEAE should be personalized, based on the patient's dominant risk profile.

каротидная эндартерэктомияобщая анестезиярегионарная анестезиянейромониторингпериоперационные осложненияcarotid endarterectomygeneral anesthesiaregional anesthesianeuromonitoringperioperative complicationsReferencesСыроватский А.А., Симутис И.С., Светликов А.В. и др. Периоперационная нейропротекция системной гипотермией при каротидной эндартерэктомии. Общая реаниматология. 2025;21(1):28-37. https://doi.org/10.15360/1813-9779-2025-1-28-37Syrovatskiy A.A., Simutis I.S., Svetlikov A.V., et al. Perioperative neuroprotection with systemic hypothermia during carotid endarterectomy. General Reanimatology. 2025;21(1):28-37. https://doi.org/10.15360/1813-9779-2025-1-28-37. in Russian.Сыроватский А.А., Сайганов С.А., Лебединский К.М. Мотивы выбора метода анестезии при выполнении каротидной эндартерэктомии. Анестезиология и реаниматология. 2022;(2):73-79. https://doi.org/10.17116/anaesthesiology202202173Syrovatskiy A.A., Sayganov S.A., Lebedinskiy K.M. Motives for choosing the anesthesia method during carotid endarterectomy. Anesteziologiya i Reanimatologiya. 2022;(2):73-79. https://doi.org/10.17116/anaesthesiology202202173 in Russian.Симонов О.В., Прямиков А.Д., Лолуев Р.Ю. и др. Регионарная анестезия при каротидной эндартерэктомии у пациентов в остром периоде ишемического инсульта (пилотное исследование). Общая реаниматология. 2022;18(6):4-11. https://doi.org/10.15360/1813-9779-2022-6-4-11Simonov O.V., Pryamikov A.D., Loluyev R.Yu., et al. Regional anesthesia for carotid endarterectomy in patients in the acute period of ischemic stroke (a pilot study). General Reanimatology. 2022;18(6):4-11. https://doi.org/10.15360/1813-9779-2022-6-4-11. in Russian.Мустафаева С.А., Журавель С.В., Михайлов И.П. и др. Опыт применения регионарной анестезии при каротидной эндартерэктомии в НИИ СП им. Н.В. Склифосовского ДЗМ. Неотложная медицинская помощь. Журнал им. Н.В. Склифосовского. 2023;12(2):333-337. https://doi.org/10.23934/2223-9022-2023-12-2-333-337Mustafaeva S.A., Zhuravel S.V., Mikhaylov I.P., et al. Experience of regional anesthesia application for carotid endarterectomy at the N.V. Sklifosovsky Research Institute for Emergency Care of the Moscow Healthcare Department. Emergency Medical Care. The Journal Named After N.V. Sklifosovsky. 2023;12(2):333-337. https://doi.org/10.23934/2223-9022-2023-12-2-333-337. in Russian.Majd P., Galkin P., Tayeh M. et al. Carotid cross-clamp intolerance during carotid endarterectomy in regional anesthesia. I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):66-72. https://doi.org/10.23888/PAVLOVJ202129166-72Majd P., Galkin P., Tayeh M., et al. Carotid cross-clamp intolerance during carotid endarterectomy in regional anesthesia. I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):66-72. https://doi.org/10.23888/PAVLOVJ202129166-72Вачёв А.Н., Прожога М.Г., Дмитриев О.В. Выбор препарата для создания управляемой системной артериальной гипертензии при выполнении операции каротидной эндартерэктомии. Клиническая физиология кровообращения. 2020;17(2):116-120. https://doi.org/10.24022/1814-6910-2020-17-2-116-120Vachev A.N., Prozhozhа M.G., Dmitriev O.V. Choosing a drug for inducing controlled systemic arterial hypertension during carotid endarterectomy. Clinical Physiology of Circulation. 2020;17(2):116-120. https://doi.org/10.24022/1814-6910-2020-17-2-116-120. in Russian.Неймарк М.И., Шмелёв В.В., Титова З.А. и др. Сравнительная оценка методов анестезии, используемых при реконструктивных операциях на сонных артериях. Вестник анестезиологии и реаниматологии. 2020;17(5):15-24. https://doi.org/10.21292/2078-5658-2020-17-5-15-24Neymark M.I., Shmelev V.V., Titova Z.A., et al. Comparative evaluation of anesthesia methods used in reconstructive surgery on carotid arteries. Vestnik Anesteziologii i Reanimatologii. 2020;17(5):15-24. https://doi.org/10.21292/2078-5658-2020-17-5-15-24. in Russian.Hewson DW, Mankoo A, Bath PM et al. The Role of Processed Electroencephalography in the Detection and Management of Acute Cerebral Ischemia: A Scoping Review. J Neurosurg Anesthesiol. 2026;38(1):43-52. https://doi.org/10.1097/ANA.0000000000001018Hewson D.W., Mankoo A., Bath P.M., et al. The Role of Processed Electroencephalography in the Detection and Management of Acute Cerebral Ischemia: A Scoping Review. J Neurosurg Anesthesiol. 2026;38(1):43-52. https://doi.org/10.1097/ANA.0000000000001018Chiumiento C, Nicolella G, Accarino G. Neuroprotection and haemodynamic stability: considerations for tailored anaesthesia in carotid endarterectomy. Eur J Anaesthesiol. 2025;42(6):569-570. https://doi.org/10.1097/EJA.0000000000002163Chiumiento C., Nicolella G., Accarino G. Neuroprotection and haemodynamic stability: considerations for tailored anaesthesia in carotid endarterectomy. Eur J Anaesthesiol. 2025;42(6):569-570. https://doi.org/10.1097/EJA.0000000000002163Li R, Sidawy A, Nguyen BN. Locoregional Versus General Anesthesia in Prolonged Carotid Endarterectomy: A Propensity Score-Matched Study from the American College of Surgeons National Surgical Quality Improvement Program Database from 2011 to 2022. Ann Vasc Surg. 2025;110(Pt A):353-364. https://doi.org/10.1016/j.avsg.2024.09.053Li R., Sidawy A., Nguyen B.N. Locoregional Versus General Anesthesia in Prolonged Carotid Endarterectomy: A Propensity Score-Matched Study from the American College of Surgeons National Surgical Quality Improvement Program Database from 2011 to 2022. Ann Vasc Surg. 2025;110(Pt A):353-364. https://doi.org/10.1016/j.avsg.2024.09.053El-Hajj VG, Ghaith AK, Gharios M et al. General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients. Neurosurgery. 2024;95(2):365-371. https://doi.org/10.1227/neu.0000000000002887El-Hajj V.G., Ghaith A.K., Gharios M., et al. General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients. Neurosurgery. 2024;95(2):365-371. https://doi.org/10.1227/neu.0000000000002887Rerkasem A, Orrapin S, Howard DP et al. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2021;10(10):CD000126. https://doi.org/10.1002/14651858.CD000126.pub5Rerkasem A., Orrapin S., Howard D.P., et al. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2021;10(10):CD000126. https://doi.org/10.1002/14651858.CD000126.pub5. in Russian.Нуриманшин А.Ф., Богданов Р.Р., Кашаев М.Ш. и др. Ретроспективный анализ анестезиологического обеспечения и видов оперативного вмешательства у пациентов с атеросклеротическим поражением сонных артерий. Уральский медицинский журнал. 2020;(7(190)):121-127. https://doi.org/10.25694/URMJ.2020.07.20Nurimanshin A.F., Bogdanov R.R., Kashaev M.Sh., et al. Retrospective analysis of anesthetic management and types of surgical interventions in patients with atherosclerotic lesions of carotid arteries. Ural Medical Journal. 2020;(7(190)):121-127. https://doi.org/10.25694/URMJ.2020.07.20. in Russian.Gyöngyösi Z, Belán I, Nagy E et al. Incomplete circle of Willis as a risk factor for intraoperative ischemic events during carotid endarterectomies performed under regional anesthesia - A prospective case-series. Transl Neurosci. 2023;14(1):20220293. https://doi.org/10.1515/tnsci-2022-0293Gyöngyösi Z., Belán I., Nagy E., et al. Incomplete circle of Willis as a risk factor for intraoperative ischemic events during carotid endarterectomies performed under regional anesthesia - A prospective case-series. Transl Neurosci. 2023;14(1):20220293. https://doi.org/10.1515/tnsci-2022-0293. in Russian.Подгурская М.Г., Хамроев С.Ш., Каньшина Д.С. и др. Комбинированный интраоперационный нейромониторинг при каротидной эндартерэктомии. Ангиология и сосудистая хирургия. Журнал им. академика А.В. Покровского. 2023;29(1):34-41. https://doi.org/10.33029/1027-6661-2023-29-1-34-41Podgurskaya M.G., Khamroyev S.Sh., Kanshina D.S., et al. Combined intraoperative neuromonitoring during carotid endarterectomy. Angiology and Vascular Surgery. Journal Named After Academician A.V. Pokrovsky. 2023;29(1):34-41. https://doi.org/10.33029/1027-6661-2023-29-1-34-41. in Russian.Gyöngyösi Z, Farkas O, Papp L et al. The value of transcranial Doppler monitoring of cerebral blood flow changes during carotid endarterectomy performed under regional anesthesia - A case series. Transl Neurosci. 2022;13(1):476-482. https://doi.org/10.1515/tnsci-2022-0257Gyöngyösi Z., Farkas O., Papp L., et al. The value of transcranial Doppler monitoring of cerebral blood flow changes during carotid endarterectomy performed under regional anesthesia - A case series. Transl Neurosci. 2022;13(1):476-482. https://doi.org/10.1515/tnsci-2022-0257. in Russian.Chamseddine H, Chahrour M, Shepard A et al. Locoregional anesthesia is associated with decreased cardiac complications in symptomatic heart failure patients undergoing carotid endarterectomy. J Vasc Surg. 2024;80(4):1131-1138.e2. https://doi.org/10.1016/j.jvs.2024.06.002Chamseddine H., Chahrour M., Shepard A., et al. Locoregional anesthesia is associated with decreased cardiac complications in symptomatic heart failure patients undergoing carotid endarterectomy. J Vasc Surg. 2024;80(4):1131-1138.e2. https://doi.org/10.1016/j.jvs.2024.06.002Chamseddine H, Chahrour M, Aboul Hosn M et al. In Patients with Heart Failure Undergoing Carotid Endarterectomy, Locoregional Anesthesia is Not Associated with Decreased Mortality, Stroke, or Myocardial Infarction Compared to General Anesthesia. Ann Vasc Surg. 2024;106:189-195. https://doi.org/10.1016/j.avsg.2024.03.017Chamseddine H., Chahrour M., Aboul Hosn M., et al. In Patients with Heart Failure Undergoing Carotid Endarterectomy, Locoregional Anesthesia is Not Associated with Decreased Mortality, Stroke, or Myocardial Infarction Compared to General Anesthesia. Ann Vasc Surg. 2024;106:189-195. https://doi.org/10.1016/j.avsg.2024.03.017Козлова К.А., Шмигельский А.В., Усачев Д.Ю. и др. Выбор анестезии при каротидной эндартерэктомии: проблема оценки риска периоперационных осложнений и тактика анестезиологического обеспечения у пациента старческого возраста с кардиологическим анамнезом. Клиническая физиология кровообращения. 2019;16(3):228-234. https://doi.org/10.24022/1814-6910-2019-16-3-228-234Kozlova K.A., Shmigelskiy A.V., Usachev D.Yu., et al. Choice of anesthesia for carotid endarterectomy: the problem of perioperative complication risk assessment and anesthetic management tactics in an elderly patient with a cardiac history. Clinical Physiology of Circulation. 2019;16(3):228-234. https://doi.org/10.24022/1814-6910-2019-16-3-228-234. in Russian.Kazantsev A.N., Korotkikh A.V., Unguryan V.M. et al. Update in carotid disease. Current Problems in Cardiology. 2023; 48(6): 101676. https://doi.org/10.1016 / j.cpcardiol.2023.101676Kazantsev A.N., Korotkikh A.V., Unguryan V.M., et al. Update in carotid disease. Current Problems in Cardiology. 2023;48(6):101676. https://doi.org/10.1016/j.cpcardiol.2023.101676. in Russian.Labanca R, Ursoleo JD, Fresilli S et al. Clevidipine versus nitroglycerin for blood pressure control during carotid endarterectomy: a cohort study. BMC Anesthesiol. 2025 Dec 15. https://doi.org/10.1186/s12871-025-03543-8Labanca R., Ursoleo J.D., Fresilli S., et al. Clevidipine versus nitroglycerin for blood pressure control during carotid endarterectomy: a cohort study. BMC Anesthesiol. 2025 Dec 15. https://doi.org/10.1186/s12871-025-03543-8Silva VA, D Gamas L, Pereira-Macedo J et al. Hemodynamic Predictors And Changes During Carotid Endarterectomy Under Regional Anesthesia. Port J Card Thorac Vasc Surg. 2025;32(1):13-23. https://doi.org/10.48729/pjctvs.502Silva V.A., D Gamas L., Pereira-Macedo J., et al. Hemodynamic Predictors And Changes During Carotid Endarterectomy Under Regional Anesthesia. Port J Card Thorac Vasc Surg. 2025;32(1):13-23. https://doi.org/10.48729/pjctvs.502Çetinkaya D, Bozdoğan RF, Şahin A et al. Evaluation of the effect of carotid sinus blockade on hemodynamic stability in carotid surgery: A retrospective study. Medicine (Baltimore). 2025;104(4):e41353. https://doi.org/10.1097/MD.0000000000041353Çetinkaya D., Bozdoğan R.F., Şahin A., et al. Evaluation of the effect of carotid sinus blockade on hemodynamic stability in carotid surgery: A retrospective study. Medicine (Baltimore). 2025;104(4):e41353. https://doi.org/10.1097/MD.0000000000041353. in Russian.Turhan Ö, Sivrikoz N, Canbolat N et al. Ultrasound-guided intermediate versus deep cervical plexus block for carotid endarterectomy: a randomized controlled study. BMC Anesthesiol. 2025;25(1):581. https://doi.org/10.1186/s12871-025-03460-wTurhan Ö., Sivrikoz N., Canbolat N., et al. Ultrasound-guided intermediate versus deep cervical plexus block for carotid endarterectomy: a randomized controlled study. BMC Anesthesiol. 2025;25(1):581. https://doi.org/10.1186/s12871-025-03460-w. in Russian.Ratnayake A, Abeysundara A, Samarasinghe B et al. Use of intermediate cervical plexus block in carotid endarterectomy -an alternative to deep cervical plexus block: a case series. BMC Anesthesiol. 2024;24(1):288. https://doi.org/10.1186/s12871-024-02674-8Ratnayake A., Abeysundara A., Samarasinghe B., et al. Use of intermediate cervical plexus block in carotid endarterectomy -an alternative to deep cervical plexus block: a case series. BMC Anesthesiol. 2024;24(1):288. https://doi.org/10.1186/s12871-024-02674-8Padmanaban V, Caldwell C, Milne I et al. Carotid endarterectomy using regional anesthesia: technique and considerations. Front Surg. 2024;11:1421624. https://doi.org/10.3389/fsurg.2024.1421624Padmanaban V., Caldwell C., Milne I., et al. Carotid endarterectomy using regional anesthesia: technique and considerations. Front Surg. 2024;11:1421624. https://doi.org/10.3389/fsurg.2024.1421624Seybold B, Gaier N, Ofenloch A et al. Learnability of Ultrasound-Guided Locoregional Anesthesia for Carotid Endarterectomy. J Clin Med. 2024;13(24):7557. https://doi.org/10.3390/jcm13247557Seybold B., Gaier N., Ofenloch A., et al. Learnability of Ultrasound-Guided Locoregional Anesthesia for Carotid Endarterectomy. J Clin Med. 2024;13(24):7557. https://doi.org/10.3390/jcm13247557Vega Colón M, López González JM, Jiménez Gómez BM et al. Prospective analysis on carotid endarterectomy: intermediate-deep ultrasound-guided cervical blockade versus general anesthesia. Minerva Anestesiol. 2023;89(7-8):636-642. https://doi.org/10.23736/S0375-9393.22.16820-3Vega Colón M., López González J.M., Jiménez Gómez B.M., et al. Prospective analysis on carotid endarterectomy: intermediate-deep ultrasound-guided cervical blockade versus general anesthesia. Minerva Anestesiol. 2023;89(7-8):636-642. https://doi.org/10.23736/S0375-9393.22.16820-3Skrtic M, Lijovic L, Pazur I et al. Hemodynamic Safety and Effect of Dexmedetomidine on Superficial Cervical Block Quality for Carotid Endarterectomy: A Prospective Study. J Cardiothorac Vasc Anesth. 2023;37(10):2006-2011. https://doi.org/10.1053/j.jvca.2023.06.009Skrtic M., Lijovic L., Pazur I., et al. Hemodynamic Safety and Effect of Dexmedetomidine on Superficial Cervical Block Quality for Carotid Endarterectomy: A Prospective Study. J Cardiothorac Vasc Anesth. 2023;37(10):2006-2011. https://doi.org/10.1053/j.jvca.2023.06.009Томащук Д.И., Мартынов Д.В., Женило В.М. Дексмедетомидин и пропофол для седации при каротидной эндартерэктомии в условиях регионарной анестезии: что лучше для пациента? (Исследование удовлетворенности пациентов). Вестник интенсивной терапии. 2017;(4):36-41. https://doi.org/10.21320/1818-474X-2017-4-36-41Tomashchuk D.I., Martynov D.V., Zhenilo V.M. Dexmedetomidine and propofol for sedation during carotid endarterectomy under regional anesthesia: which is better for the patient? (A study of patient satisfaction). Vestnik Intensivnoy Terapii. 2017;(4):36-41. https://doi.org/10.21320/1818-474X-2017-4-36-41. in Russian.Gao J, Yang C, Ji Q et al. Effect of remimazolam versus propofol for the induction of general anesthesia on cerebral blood flow and oxygen saturation in elderly patients undergoing carotid endarterectomy. BMC Anesthesiol. 2023;23(1):153. https://doi.org/10.1186/s12871-023-02095-zGao J., Yang C., Ji Q., et al. Effect of remimazolam versus propofol for the induction of general anesthesia on cerebral blood flow and oxygen saturation in elderly patients undergoing carotid endarterectomy. BMC Anesthesiol. 2023;23(1):153. https://doi.org/10.1186/s12871-023-02095-zKerndl H, Millian TP, Gürtler K et al. Measuring Stress Reduction in Patients Receiving Multimedia Entertainment During Vascular Surgery Under Regional Anesthesia: Protocol for a Randomized Controlled Study. JMIR Res Protoc. 2025;14:e70597. https://doi.org/10.2196/70597Kerndl H., Millian T.P., Gürtler K., et al. Measuring Stress Reduction in Patients Receiving Multimedia Entertainment During Vascular Surgery Under Regional Anesthesia: Protocol for a Randomized Controlled Study. JMIR Res Protoc. 2025;14:e70597. https://doi.org/10.2196/70597Duarte-Gamas L, Fragão-Marques M, Zlatanovic P et al. The diagnostic accuracy of intraoperative near-infrared spectroscopy in carotid artery endarterectomy under general anesthesia: A systematic review with meta-analysis. Scand J Surg. 2025;114(1):84-94. https://doi.org/10.1177/14574969241282611Duarte-Gamas L., Fragão-Marques M., Zlatanovic P., et al. The diagnostic accuracy of intraoperative near-infrared spectroscopy in carotid artery endarterectomy under general anesthesia: A systematic review with meta-analysis. Scand J Surg. 2025;114(1):84-94. https://doi.org/10.1177/14574969241282611Tomić Mahečić T, Malojčić B, Tonković D et al. Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial. J Clin Med. 2023;12(15):4885. https://doi.org/10.3390/jcm12154885Tomić Mahečić T., Malojčić B., Tonković D., et al. Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial. J Clin Med. 2023;12(15):4885. https://doi.org/10.3390/jcm12154885Alhaizaey A, Yousif M, Azazy A et al. Prospective single-center study on the reliability of ipsilateral cerebral oximetry using near-infrared spectroscopy as a predictor for selective shunting during carotid endarterectomy. Vascular. 2024;32(6):1304-1308. https://doi.org/10.1177/17085381231214596Alhaizaey A., Yousif M., Azazy A., et al. Prospective single-center study on the reliability of ipsilateral cerebral oximetry using near-infrared spectroscopy as a predictor for selective shunting during carotid endarterectomy. Vascular. 2024;32(6):1304-1308. https://doi.org/10.1177/17085381231214596Lindberg M, Gillgren P, Gunnarsson K et al. Near Infrared Spectroscopy Versus Stump Pressure in Detecting Cerebral Ischemia During Carotid Endarterectomy: A Prospective Multicenter Observational Study. Ann Vasc Surg. 2025;123:608-616. https://doi.org/10.1016/j.avsg.2025.10.016Lindberg M., Gillgren P., Gunnarsson K., et al. Near Infrared Spectroscopy Versus Stump Pressure in Detecting Cerebral Ischemia During Carotid Endarterectomy: A Prospective Multicenter Observational Study. Ann Vasc Surg. 2025;123:608-616. https://doi.org/10.1016/j.avsg.2025.10.016Duarte-Gamas L, Pereira-Neves A, Sousa J et al. The Diagnostic Accuracy of Intra-Operative Near Infrared Spectroscopy in Carotid Artery Endarterectomy Under Regional Anaesthesia: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2021;62(4):522-531. https://doi.org/10.1016/j.ejvs.2021.05.042Duarte-Gamas L., Pereira-Neves A., Sousa J., et al. The Diagnostic Accuracy of Intra-Operative Near Infrared Spectroscopy in Carotid Artery Endarterectomy Under Regional Anaesthesia: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2021;62(4):522-531. https://doi.org/10.1016/j.ejvs.2021.05.042Wang B, Li S, Wang C et al. Effect of sevoflurane post-conditioning on postoperative cognitive function in carotid endarterectomy patients: a randomized, double-blind, controlled trial. Front Med (Lausanne). 2025;12:1716370. https://doi.org/10.3389/fmed.2025.1716370Wang B., Li S., Wang C., et al. Effect of sevoflurane post-conditioning on postoperative cognitive function in carotid endarterectomy patients: a randomized, double-blind, controlled trial. Front Med (Lausanne). 2025;12:1716370. https://doi.org/10.3389/fmed.2025.1716370Yang F, Du Y, Yuan C et al. Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy. Am J Transl Res. 2024;16(3):1018-1028. https://doi.org/10.62347/RXRN7802Yang F., Du Y., Yuan C., et al. Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy. Am J Transl Res. 2024;16(3):1018-1028. https://doi.org/10.62347/RXRN7802Dahi M, Moshari M, Dabir S et al. Effect of Vitamin C Infusion on Cerebral Oximetry During General Anesthesia for Carotid Endarterectomy in Diabetic Patients. Anesth Pain Med. 2023;13(1):e134000. https://doi.org/10.5812/aapm-134000Dahi M., Moshari M., Dabir S., et al. Effect of Vitamin C Infusion on Cerebral Oximetry During General Anesthesia for Carotid Endarterectomy in Diabetic Patients. Anesth Pain Med. 2023;13(1):e134000. https://doi.org/10.5812/aapm-134000

The authors declare that there are no conflicts of interest present.