Avoidance of Cranial Nerve Palsies Occurring after Carotid Endarterectomy: An Analysis of 216 Consecutive Cases

Cranial nerve palsy occurring after carotid endarterectomy (CEA) is the most common recognized complication, along with others such as stroke and myocardial infarction (MI). We examined the incidence and follow-up of cranial nerve palsy and other periprocedural major adverse events in 216 consecutive CEAs performed between January 2006 and December 2012. Six cranial nerve palsies (2 dysphonia, 1 dysphagia, 1 tongue hemiparesis, and 2 first bite syndromes) were identified in 4 patients (1.9%). All symptoms were transient and the patients recovered within 3 months. The incidence of perioperative stroke, death, and MI was 0%. Diffusion-weighted imaging performed on the day after surgery revealed an asymptomatic single spotty lesion in only 2 patients (0.9%). An optimal and meticulously conducted surgery based on a thorough knowledge of surgical anatomy could enable surgeons to avoid cranial nerve palsy and other major complications associated with CEA.