A new review may not ultimately settle the debate on general vs. local anesthesia for carotid endarterectomy. Only in analysis of observational studies showed reduced risk of stroke, TIA, MI and mortality. Randomized trial analysis did not show these benefits. LA decreased shunt insertion which may in itself increased embolic stroke.
All in all they conclude “Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials”. Nonetheless as the gold standard, further randomized studies may be needed to settle the debate to account for confounding and other variables.