SS06 - Cranial Nerve Injuries Post Carotid Endarterectomy: A 15-Year Prospective Study with Routine Otolaryngologist and Neurological Evaluation

Objectives: The aim of this prospective monocentric cohort study was to analyze the incidence of cranial nerve injuries related to carotid endarterectomy (CEA) surgery over the past 15 years in our academic center and to identify correlated risk factors.

Methods: From January 2007 to December 2022, a total of 3794 consecutive CEA procedures were performed and prospectively recorded in a dedicated database. Cranial nerve injuries were assessed and defined according to a standardized protocol. Preoperative specialized otolaryngologist evaluations were conducted within 30 days before intervention, whereas postoperative controls were performed before discharge. Preoperative neurological assessments were carried out in all patients with symptomatic carotid stenosis, while postoperative neurological evaluations were performed in all patients, regardless of lesion symptoms. Patients with newly onset cranial nerve injuries underwent follow-up assessments at 30 days and, if necessary, at 6 and 12 months. Perioperative results, including mortality, major central neurological events, and postoperative cranial nerve injuries, were analyzed. Regression or persistence of lesions during follow-up visits was assessed, and multivariate analysis (binary logistic regression) was conducted to evaluate clinical, anatomical, and surgical technique factors influencing the occurrence of cranial nerve injuries.

Results: Perioperative mortality was 0.4%, and the 30-day stroke rate was 0.3%. Early evaluations identified 263 motor cranial nerve injuries, accounting for 6.9% of the entire study group. Of these, 116 affected the hypoglossal nerve, 91 the facial nerve, 49 the laryngeal nerve, and 7 other nerves such as the glossopharyngeal and accessory nerves. Twelve patients had lesions in more than one cranial nerve. In 66% of cases, the 30-day visit showed complete resolution of the deficit, while 36% of patients presented persistent nerve deficits (overall rate of persistent deficit was 2.3%). Multivariate analysis demonstrated that the risk of nerve injury significantly and independently increased in symptomatic patients treated urgently, patients operated for carotid restenosis, and patients with postoperative hematoma requiring surgical revision. Conversely, primary interventions in asymptomatic carotid stenosis patients were independently associated with a reduced risk of cranial nerve injuries.

Conclusions: Our study data highlight that the risk of developing persistent cranial nerve injuries after CEA is low, even when assessments are conducted by otolaryngologist and neurological specialists rather than the surgeon. In this context, the collaboration of a multidisciplinary team is crucial for early identification of patients at high risk of developing such complications and determining when to adopt alternative surgical strategies.