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Eur J Vasc Endovasc Surg. 2014 Jan;47(1):2-7. doi: 10.1016/j.ejvs.2013.09.022. Epub 2013 Oct 1.

Clinical relevance of cranial nerve injury following carotid endarterectomy.

Author information

  • 1Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; University Medical Center Utrecht, Utrecht, The Netherlands.
  • 2University Medical Center Utrecht, Utrecht, The Netherlands.
  • 3Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
  • 4Yale Medical Center, New Haven, CT, USA.
  • 5Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
  • 6Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: mscherme@bidmc.harvard.edu.



The benefit of carotid endarterectomy (CEA) may be diminished by cranial nerve injury (CNI). Using a quality improvement registry, we aimed to identify the nerves affected, duration of symptoms (transient vs. persistent), and clinical predictors of CNI.


We identified all patients undergoing CEA in the Vascular Study Group of New England (VSGNE) between 2003 and 2011. Surgeon-observed CNI rate was determined at discharge (postoperative CNI) and at follow-up to determine persistent CNI (CNIs that persisted at routine follow-up visit). Hierarchical multivariable model controlling for surgeon and hospital was used to assess independent predictors for postoperative CNI.


A total of 6,878 patients (33.8% symptomatic) were included for analyses. CNI rate at discharge was 5.6% (n = 382). Sixty patients (0.7%) had more than one nerve affected. The hypoglossal nerve was most frequently involved (n = 185, 2.7%), followed by the facial (n = 128, 1.9%), the vagus (n = 49, 0.7%), and the glossopharyngeal (n = 33, 0.5%) nerve. The vast majority of these CNIs were transient; only 47 patients (0.7%) had a persistent CNI at their follow-up visit (median 10.0 months, range 0.3-15.6 months). Patients with perioperative stroke (0.9%, n = 64) had significantly higher risk of CNI (n = 15, CNI risk 23.4%, p < .01). Predictors for CNI were urgent procedures (OR 1.6, 95% CI 1.2-2.1, p < .01), immediate re-exploration after closure under the same anesthetic (OR 2.0, 95% CI 1.3-3.0, p < .01), and return to the operating room for a neurologic event or bleeding (OR 2.3, 95% CI 1.4-3.8, p < .01), but not redo CEA (OR 1.0, 95% CI 0.5-1.9, p = .90) or prior cervical radiation (OR 0.9, 95% CI 0.3-2.5, p = .80).


As patients are currently selected in the VSGNE, persistent CNI after CEA is rare. While conditions of urgency and (sub)acute reintervention carried increased risk for postoperative CNI, a history of prior ipsilateral CEA or cervical radiation was not associated with increased CNI rate.

Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.


Carotid; Cranial nerve injury; Endarterectomy

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[Available on 2015/1/1]
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