1211 - Multidisciplinary Management of a Brachial Plexus Injury Post-TransCarotid Artery Revascularization: A Case Study

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SG

Sneha Gundavarpu, MD

Resident Physician
Medstar Georgetown National Rehabilitation Hospital
Washington, District of Columbia, United States

Co-Author(s)

LM

Laura Malmut, MD, MEd

Medical Director of Transplant Rehabilitation; Clerkship Director; Associate Professor
MedStar National Rehabilitation Hospital and Georgetown University School of Medicine
Washington, District of Columbia, United States

Submitter(s)

SG

Sneha Gundavarpu, MD

Medstar Georgetown
Washington, District of Columbia, United States

Case Diagnosis: Brachial plexus injury following left transcarotid artery revascularization (TCAR).

Case Description: Patient is a 76-year-old female with a history of right parietal stroke with right internal carotid artery (ICA) occlusion and left external carotid artery (ECA) occlusion who was admitted for a planned left TCAR. Following the TCAR, the patient developed left arm weakness with 0/5 strength in left shoulder abduction, 1/5 elbow flexion and 5/5 strength distally, a significant change from her full strength prior. She was diagnosed with a C5-C6 left brachial plexopathy due to upper extremity positioning/compression during the procedure.
Upon arrival at the acute rehabilitation hospital, she required contact guard assistance (CGA) with bed mobility, minimal assistance with transfers, ambulation, and stairs. Upon discharge, she required supervision for bed mobility and transfers and CGA for ambulation and stairs. With occupational therapy, she improved to requiring minimal assistance for dressing and supervision for walking.

Discussions: Patient obtained an MRI of the brain and C spine, which showed no lesions. MRI of the brachial plexus showed local edema. An EMG was done outpatient which showed moderate to severe axonal injury to the upper brachial plexus with diminished neural transmission to the muscles. Her presentation was consistent with C5-C6 brachial plexopathy.

This case highlights the rare occurrence of brachial plexus injury following TCAR, particularly in patients with complex vascular histories. This case emphasizes the importance of recognizing such complications and implementing a multidisciplinary approach for optimal patient care.

Conclusions: Brachial plexus injury is a rare but significant complication of TCAR. Prompt recognition and intervention are essential. This case underscores the need for comprehensive post-operative care, including early rehabilitation, to improve functional recovery and outcomes in patients experiencing such complications.