Literature Review of Cranial Nerve Injuries During Carotid Endarterectomy

Sajid, Muhammad Shafique; Vijaynagar, Badri; Singh, Prateush; Hamilton, George

doi:10.1080/00015458.2007.11680006

Cited by 47 publications

(32 citation statements)

References 17 publications

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“…50 A literature review calculated a 9% risk (range, 2%-27%) of temporary palsy after CEA in patients without a hostile neck. 51 Two other extensive studies reported a rate of 5.0% with only 0.5% lasting more than a few months in patients at normal risk. 52,53 Furthermore, a rate of 7.7% in a high-risk group with local risk factors was observed without a significant difference with the reference low-risk group (6.6%).…”

Section: Discussionmentioning

confidence: 99%

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy

Fokkema

Hartog

Bots

et al. 2012

Stroke

121

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Background and Purpose-Patients with both carotid stenosis and previously cervical radiation therapy are considered "high risk" for carotid endarterectomy (CEA). Carotid angioplasty and stenting (CAS) seems a reasonable alternative, but neither the operative risk for CEA nor the effectiveness of CAS has been proven. The purpose of this study was to evaluate perioperative and long-term outcome of both procedures in patients with radiation therapy. Methods-A systematic search strategy with the synonyms "carotid artery stenosis" and "cervical irradiation" was conducted in MEDLINE and EMBASE databases. To provide and compare estimates of outcomes, pooled and metaregression analyses were performed. Results-Twenty-seven articles comprising 533 patients undergoing radiation therapy (361 CAS and 172 CEA) fulfilled our inclusion criteria. Pooled analysis showed perioperative risk for "any cerebrovascular adverse event" (CVE) of 3.9% (95% CI, 2.3%-6.7%) in CAS studies against 3.5% (95% CI, 1.5%-8.0%) in CEA studies (Pϭ0.77). Risk for cranial nerve injury (CNI) after CEA was 9.2% (95% CI, 3.7%-21.1%) versus none after CAS. Late outcome showed rates of CVE favoring CEA (Pϭ0.014). The rate of restenosis Ͼ50% was significantly higher in patients treated with CAS compared with CEA (PϽ0.003). Conclusions-Both CAS and CEA proved to be feasible revascularization techniques with low risk for CVE. Although patients undergoing CEA had more temporary CNI, higher rates of late CVE and restenosis were identified after CAS.

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Section: Discussionmentioning

confidence: 99%

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy

Fokkema

Hartog

Bots

et al. 2012

Stroke

121

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“…This is much lower than the figures reported in the literature (up to 8%). [27] This may be due to the experience of the team performing CEA.…”

Section: Discussionmentioning

confidence: 99%

The influence of diabetes mellitus on early outcome following carotid endarterectomy

Mulaudzi¹,

Robbs²

2015

S Afr J Surg

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Background. There are few studies that look at the influence of diabetes mellitus on early outcome following carotid endarterectomy (CEA). Those available have reported conflicting results, with some showing poor outcome and others similar outcome to those without diabetes mellitus. Objective. To assess the influence of diabetes mellitus on early outcome following CEA. Methods. Clinical data on patients who had CEA over a 5-year period were acquired from a prospectively maintained computerised database. They were divided into two groups, namely diabetics and non-diabetics. Results. Two hundred and sixty-four charts were analysed. There were no significant differences in patient demographics and risk factors for atherosclerosis between the two groups. The majority (71%) of patients had CEA for symptomatic carotid disease. Carotid shunting was performed selectively, and significantly more diabetic patients had CEA under the protection of a carotid shunt (p=0.0469). Postoperative strokes, transient ischaemic attacks and deaths were not significantly different between the two groups. Conclusions. Diabetes mellitus had no influence on the early surgical outcome following carotid endarterectomy.

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“…His aim was to disclose the incidence of CNI after surgery and changes thereof during the last 25 years. He reported that CNI is still a significant postoperative complication after CEA but with decreasing incidence despite the increasing numbers of CEA procedures [37]. Mehta et al reported an incidence of CNI of 3% in 59 patients in redo CEA procedures [36].…”

Section: Cranial Nerve Injuries (Cni)mentioning

confidence: 98%

“…Infrequently CNI may be life-threatening in cases of injury of the glossopharyngeal or bilateral recurrent laryngeal nerve. The literature reports a broad range of incidence ranging from less than 1-25% of CNI after CEA whereby the lowest rates are seen in the center with a high volume of carotid artery endarterectomies [18,[33][34][35][36][37][38][39] (Table 3). Sajid et al reviewed the literature with regard to CNI after CEA.…”

Section: Cranial Nerve Injuries (Cni)mentioning

confidence: 99%

Competitive strategies for surgery in the treatment of primary internal carotid artery (ICA) stenosis

2008

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Kompetitive Strategien der Chirurgie bei der Behandlung der primären Carotisstenose Zusammenfassung. Grundlagen: Die Chirurgie hat sich in der Therapie der hochgradigen Karotisstenose als Goldstandard etabliert. In den letzten Jahren wird jedoch vermehrt die endovaskuläre Sanierung mittels perkutaner Angioplastie und Stentimplantation propagiert. Das Ziel dieser Arbeit ist, die Argumente der Proponenten gegen die Chirurgie (größere Belastung für den Patienten, gefährli-chere Intervention, höhere Mortalität etc.) näher zu beleuchten und moderne Strategien zu präsentieren, mit welchen die chirurgische Therapie kompetitiv gegen diese Strömungen bestehen kann. Methodik: Medline (1995 und Cochrane Library Electronic Databases (2007) wurden nach prospektiv randomisierten Publikationen, welche sich mit der chirurgischen und endovaskulären Behandlung der Karotisstenose beschäftigen, durchsucht. Die Resultate dieser Publikationen wurden im Sinne einer Meta-Analyse miteinander verknüpft und in den verschiedenen Domä-nen (Mortalität, Schlaganfallrate, Komplikationsrate, Krankenhausaufenthalt und Kosten) verglichen. Daraus wurden mögliche Strategien für eine erfolgreiche und komplikationsarme Karotisintervention abgeleitet.Ergebnisse: Während die chirurgische Behandlung der Karotisstenose durch große randomisierte Multicenterstudien ihren Stellenwert in der Therapie dieser Erkrankung bereits bewiesen hat, sind diesbezügliche Daten seitens der Karotisstentung noch nicht Level I basiert. Studien, welche Karotisoperation mit Karotisstentung direkt verglichen haben, mussten teilweise wegen vermehrten Auftretens von neurologischen Komplikationen im Stentarm vorzeitig abgebrochen werden. Derzeit gibt es keinen prospektiv randomisierten Vergleich der die Stentbehandlung im Vorteil gegenüber der chirurgischen Therapie sieht.Schlussfolgerungen: Die Eversionsendarterektomie der Karotisstenose in Lokoregionalanästhesie erfüllt die Ansprüche eines modernen und kompetitiven operativen Konzepts. Sie kann rasch, sicher und einfach durchgeführt werden. Zudem ist das operative Verfahren billig und der Krankenhausaufenthalt limitiert. Die interventionelle Therapie stellt lediglich bei Rezidivstenosen und hostilem Hals eine Alternative zur Operation dar.Schlüsselwörter: Karotisstenose, Endarteriektomie, Stent, Angioplastie, randomisierte Studien.Summary. Background: Surgery remains the gold standard in the treatment of internal carotid artery (ICA) stenosis. In the last 10 years endovascular treatment of ICA lesions by carotid artery stenting (CAS) has become increasingly popular. The aim of this study is to assess the arguments of carotid endarterectomy (CEA) adversaries (increased physical stress for the patient, complicated procedure, higher mortality, etc.) and to present modern strategies, by which CEA as competitive treatment modality is able to withstand the current trend towards endovascular management of ICA stenosis.Methods: Medline (1995Medline ( -2007 and Cochrane Electronic Databases (2007) were searched for prospectively randomi...

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Literature Review of Cranial Nerve Injuries During Carotid Endarterectomy

Abstract: CNI is still a significant postoperative complication of carotid endarterectomy. Despite increasing use of CEA, the incidence of CNI has decreased probably because of increased awareness of the possibility of cranial nerve damage.

Cited by 47 publications

References 17 publications

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy

The influence of diabetes mellitus on early outcome following carotid endarterectomy

Competitive strategies for surgery in the treatment of primary internal carotid artery (ICA) stenosis

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