Cranial Nerve Injury After Carotid Endarterectomy: Incidence, Risk Factors, and Time Trends

Area of Science:

• Vascular Surgery
• Neurology
• Medical Statistics

Background:

• Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
• Cranial nerve injury (CNI) is a potential complication following CEA.
• Understanding the incidence and risk factors for CNI is crucial for patient safety and procedural decision-making.

Purpose of the Study:

• To determine the incidence of cranial nerve injury (CNI) after carotid endarterectomy (CEA).
• To identify risk factors associated with an increased likelihood of CNI post-CEA.

Main Methods:

• A meta-analysis of 26 studies (1970-2015) involving 20,860 CEAs.
• Pooled rates and confidence intervals (CIs) calculated for CNIs.
• Odds ratios (ORs) determined for potential risk factors; meta-regression analyzed publication year's influence.

Main Results:

• The vagus nerve (3.99%) and hypoglossal nerve (3.79%) were most frequently injured post-CEA.
• Permanent injuries were infrequent: 0.57% for vagus nerve, 0.15% for hypoglossal nerve.
• Urgent procedures and return to OR for complications increased CNI risk; injury rates decreased over 35 years.

Conclusions:

• Vagus and hypoglossal nerves are most susceptible to injury after CEA, with low rates of permanent damage.
• The declining incidence of CNI suggests it is less of a deciding factor when comparing CEA to stenting.
• Risk factors like urgent procedures and reoperation increase CNI likelihood.