Dysphagia in post-carotid endarterectomy: a prospective study

Dysphagia can be a debilitating complication in carotid endarterectomy. This study describes our experience in the management of this complication. We prospectively assembled an inception cohort of 19 consecutive, hospital-referred patients with dysphagia post-carotid endarterectomy. We performed swallowing evaluation in all the recruited patients both at the bedside and by fiberoptic endoscopic evaluation of swallowing (FEES) 5 days and 3 months after the operation, using standardized methods and diagnostic criteria. The degree of dysphagia was scored using the Penetration-Aspiration Scale (PAS). All patients were undergoing early rehabilitation treatment and were followed up prospectively for 3 months, during which time recovery of swallowing function and any occurrence of pneumonia were recorded. At baseline, 15 patients presented dysphagia for liquid and solid food and four for solid food only, eight were on parenteral nutrition, and six presented bronchial aspiration (by FEES). The mean PAS score at the first evaluation was 5.2. Ten patients completely recovered swallowing function and returned to their preoperative diet within 1 month, and six did so within 3 months; the other three patients did not complete the follow-up. No patient presented pneumonia. At the 3-month follow-up, one patient presented bronchial aspiration and the mean PAS score was 1.2. This preliminary experience suggests that careful evaluation of swallowing and early rehabilitation may be advisable in these patients.