You are assessing a 73 year old male who has been referred by the stroke team for an episode of (Lt Arm and leg weakness that completely recovered). He has history of undergoing a thyroidectomy 10 year ago for Ca thyroid for which he also underwent post-operative radiotherapy.
Discuss your management and consent process.
This patient has a hostile neck due to previous surgery and radiation. CAS would be a better option than CEA in such case. We would explain the technique to patient and illustrate the potential complications of open surgery in that situation as cranial nerve injury and stroke
Discuss your management and consent process.
I will ask for carotid doppler if it shows more than 50% stenosis another carotid doppler should be considered or CTA then CAS should be considered as its hostile neck from radiation and surgery .
I will discuss the possibility of peri operative stroke as the incidence of stroke is higher in CAS
This patient has a hostile neck due to previous surgery and radiation. CAS would be a better option than CEA in such case. We would explain the technique to patient and illustrate the potential complications of open surgery in that situation as cranial nerve injury and stroke.
patients with a history of radiation therapy to the neck are at higher risk of developing temporary cranial nerve injury during CEA, and also at increased risk of late cerebrovascular events and restenosis following CAS.
CEA is more technically challenging in the radiated neck because these patients tend to have more diffuse plaques, as well as adhesions, scar tissue, and wound complications as a result of radiation
Thank you for excellent response