What are the risks associated with carotid endarterectomy?

What are the risks of a carotid endarterectomy? So the risks of carotid endarterectomy again I think can be divided into risks as a direct result of the surgery. So there are obviously being in the neck, there are a number of nerves that run alongside the carotid. One is the recurrent laryngeal nerve nerve, which controls phonation and the voice box. The other one is the hypoglossal nerve, which controls the muscle at the base of the tongue. Now, most of these nerves run in pairs, provided the patient hasn't had surgery on the other side. If you injure one recurrent laryngeal nerve, the longer term consequence is really a hoarseness of the voice. If you injure the hypoglossal nerve, you get tongue deviation or movement of the tongue towards the side of the operation. So if you had a left-sided carotid endarterectomy and you injured the hypoglossal nerve, the tongue will deviate towards that side. Tongue deviation is actually reasonably frequent and is more down to the retraction applied during the carotid endarterectomy, so they get what's referred to as neuropraxia or that the nerve transiently falls asleep as a result of direct pressure and handling but it tends to get better after a number of days. The other risks of carotid endarterectomy that we've already discussed, hematomas and bleeding, myocardial infarction, I mentioned to you before that for reasons that aren't quite understood, you know, atherosclerotic disease is an inflammatory process and you get activation of plaques at certain time points and very much in keeping with activation of a carotid plaque, there may also be activation of plaque or increasing inflammation of plaque and friability within the coronary circulation, so heart attacks are a risk in carotid endarterectomy as well. then obviously there's the chance of actually causing a stroke. So in the United Kingdom, surgeons collect data on their outcomes. One of the operations that is very closely audited is carotid endarterectomy and the stroke rate that an individual surgeon has is widely published. There is also the stroke rate of the unit, which is quite important to discuss. So the overall stroke rate amongst all the surgeons within that unit for the cohort of patients they've operated on in the previous year. A lot of people tend to quote both the unit stroke rate and their own stroke rate. You can also talk about the national average but that gets a bit confusing. So causing a stroke, yes that is a complication that needs to be discussed with the patient because ultimately the aim of the operation is to prevent stroke but we think the trade-off certainly for symptomatic carotids if a patient has a transient ischemic attack or a stroke there's about a 15 to 20 chance of having another major fatal disabling stroke within the fortnight and you trade that off say against the two percent chance of causing a stroke during the operation.