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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.

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

Carotid; Cranial nerve injury; Endarterectomy

PMID:
24157257
[PubMed - indexed for MEDLINE]
PMCID:
PMC4096657
[Available on 2015/1/1]
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