Editing Carotid endarterectomy (section)

== Complications to CEA ==

* Mortality - 0.5% - most commonly cardiac disease
* Stroke - 1-5% - depends on indication for CEA - higher if symptomatic
* MI - 2-4%
* Cerebral hyperperfusion syndrome
** Manifests several days after, with migraine-like headaches and possibly seizures and subsequently haemorrhagic stroke
** Occurs due to dysregulation in the setting of severe contralateral carotid diseasej
** This is why strict BP control is paramount
* Labile blood pressure - 60% - generally resolves within 4-8 hours
** Hypertension - Rutherford's says IV sodium nitroprusside - titrate to keep to within 200mmHg of pre-op level. Give GTN additionally if myocardial ischaemia is present.
** Hypotension - aim for within 200mmHg of pre-op level by the usual means.
* Bleeding requiring re-exploration - 1-4%
* Infection <1%
* Cranial nerve injury - 5%-17% - mostly transient
** Mostly hypoglossal - ipsilateral tongue weakness and deviation of tongue to affected side
** RLN - hoarse voice
** SLN - early fatiguability of voice and difficulty with voice modulation/mild swallowing difficulty
** Marginal mandibular branch of facial nerve - drooping of ipsilateral lower lip - of little functional significance
** Glossopharyngeal - mild dysphagia to recurrent aspiration
** Spinal accessory nerve
** Greater auricular - numbness of angle of mandible and lower ear
** Transverse cervical - anaesthesia of anterior neck skin
**
* Recurrent carotid stenosis - 5-22%
** Usually results from intimal hyperplasia
** Could actually represent residual disease after first CEA
** Higher chance in women, continue to smoke, hypercholesterolaemia, diabetes, HTN
** 'Early' means within 2 years - typically intimal hyperplasia
** 'Late' is typically because of atherosclerotic disease