Carotid artery endarterectomy complications [Neurosurgery Wiki]

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====== Carotid artery endarterectomy complications ======


see [[Vernet’s syndrome]].

Stroke in the immediate postoperative period after carotid endarterectomy is a rare complication. Many centers have begun incorporating angiography before surgical re-exploration, which has the advantage of confirming carotid occlusion and treating tandem intracranial lesions if present.

Emergent endovascular evaluation in the setting of acute postcarotid endarterectomy thrombosis is a safe and timely treatment option, with the benefit of detecting and treating embolic intracranial lesions. Immediate angiography and intervention in this rare surgical complication show promising initial results
((Spiotta AM, Vargas J, Zuckerman S, Mokin M, Ahmed A, Mocco J, Turner RD, Turk 
AS, Chaudry MI, Myers P. Acute stroke after carotid endarterectomy: time for a
paradigm shift? Multicenter experience with emergent carotid artery stenting with
or without intracranial tandem occlusion thrombectomy. Neurosurgery. 2015
Apr;76(4):403-10. doi: 10.1227/NEU.0000000000000642. PubMed PMID: 25621982.)).

===Cranial nerve palsy (CNP) and neck haematoma=== 
CNP remains relatively common after CEA, but is rarely disabling. Women should be warned about an increased risk. Attention to haemostasis might reduce the incidence of CNP
((Doig D, Turner EL, Dobson J, Featherstone RL, de Borst GJ, Brown MM, Richards 
T; ICSS Investigators. Incidence, impact, and predictors of cranial nerve palsy
and haematoma following carotid endarterectomy in the international carotid
stenting study. Eur J Vasc Endovasc Surg. 2014 Nov;48(5):498-504. doi:
10.1016/j.ejvs.2014.08.002. Epub 2014 Oct 2. PubMed PMID: 25344019; PubMed
Central PMCID: PMC4225222.
)).

===Ischemic brain lesions===
Brain lesions on diffusion-weighted imaging (DWI) are frequently found after carotid artery stenting (CAS), but their clinical relevance remains unclear.

Ischemic brain lesions discovered on DWI after CAS seem to be a marker of increased risk for recurrent cerebrovascular events. Patients with periprocedural DWI lesions might benefit from more aggressive and prolonged antiplatelet therapy after CAS. (A Randomised Comparison of the Risks, Benefits and Cost Effectiveness of Primary Carotid Stenting With Carotid Endarterectomy: International Carotid Stenting Study; ISRCTN25337470)
((Gensicke H, van der Worp HB, Nederkoorn PJ, Macdonald S, Gaines PA, van der
Lugt A, Mali WP, Lyrer PA, Peters N, Featherstone RL, de Borst GJ, Engelter ST,
Brown MM, Bonati LH; ICSS-MRI Substudy Investigators. Ischemic brain lesions
after carotid artery stenting increase future cerebrovascular risk. J Am Coll
Cardiol. 2015 Feb 17;65(6):521-9. doi: 10.1016/j.jacc.2014.11.038. PubMed PMID:
25677309; PubMed Central PMCID: PMC4323145.)).