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 PS40. Risk of Cranial Nerve Palsy Following Carotid Endarterectomy

PS40. Risk of Cranial Nerve Palsy Following Carotid Endarterectomy
Margriet Fokkema1, Gert Jan de Borst2, Brian Nolan3, Jeffrey E. Indes4, Ruby C. Lo1, Thomas Curran1, Dominique B. Buck1, Frans L. Moll2, Marc L. Schermerhorn1
1Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 2University Medical Center Utrecht, Utrecht, Netherlands; 3Dartmouth-Hitchcock Medical Center, Lebanon, NH; 4Yale University School of Medicine, New Haven, CT.

 

OBJECTIVES: To evaluate transient and persistent cranial nerve palsy (CNP) after carotid endarterectomy (CEA), the nerves affected and predictors for CNP.
 
METHODS: All CEA patients in the Vascular Study Group of New England were identified between 2003-2011. Primary endpoints were CNP at discharge and persistent CNP at follow-up (median 1 year). Hierarchical multivariable model controlling for surgeon and hospital was used to assess independent predictors.
 
RESULTS: 6,878 patients (33.8% symptomatic) were included for analyses. 1.3% of patients had prior cervical radiation and 2.2% of patients underwent redo-CEA. CNP rate at discharge was 5.6% (n=382). Sixty patients (0.7%) had more than 1 branch affected. The hypoglossal nerve (XII) was most frequently involved (n=185, 2.7%), followed by the facial (VII, n=128, 1.9%), the vagus (X, n=49, 0.7%) and the glossopharyngeal (IX, n=33, 0.5%) (Table 1). Patients with perioperative stroke (0.9%, n=64) had significant higher risk for CNP (n=15, CNP risk: 23.4% p<0.001). Length of hospital stay was longer in patients with a CNP compared to those without (2 days vs. 1.5 day, p<0.001). The vast majority of lesions were transient; only 47 patients (0.7%) had a persistent CNP. Predictors for CNP were urgent (OR 1.5 [1.1-2.0] p=0.04) and emergent operations (OR 2.6 [1.2-5.5] p= 0.02), re-exploration during primary procedure (OR 2.0 [1.3-3.0] p=0.009) and return to the operating room (OR 2.4 [1.4-3.8] p=0.004), but not redo-CEA (OR 1.0 [0.5-2.1 p=0.9) or prior radiation (OR 0.9 [0.3-2.5] p=0.8).
 
CONCLUSIONS: While the rate of persistent CNP was low, surgeons should take particular care to protect specific nerves in conditions of urgency, re-exploration and return to OR.
 
AUTHOR DISCLOSURES: D. Buck: Nothing to disclose; T. Curran: Nothing to disclose; G. de Borst: Nothing to disclose; M. Fokkema: Nothing to disclose; J. E. Indes: Nothing to disclose; R. C. Lo: Nothing to disclose; F. L. Moll: Nothing to disclose; B. Nolan: Nothing to disclose; M. L. Schermerhorn: Endologix, Ownership or partnership; Medtronic, Ownership or partnership.
 
Total %
Urgent %
Emergent %
Re-exploration %
Return to OR %
Total (n=6878)
5.6
6.9
16.3
9.7
14.4
CN VII
1.9
2.2*
9.3*
2.8
8.1*
CN IX
0.5
0.5*
4.7*
0.5
3.6*
CN X
0.7
0.9
0
2.8*
4.5*
CN XII
2.7
3.1*
11.6*
4.6
4.5

CN, cranial nerve * p<0.05

 

Posted April 2013

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