Maximum Preservation of the Media in Carotid Endarterectomy

Abstract

Carotid endarterectomy (CEA) is intended to remove atheromatous plaque by dissecting a plane between the intima and the media (circular medial fibers), but this may not be the optimal dissection plane. The present technique is based on identifying the plane that divides the media from the plaque, so preserving the media on the adventitia as much as possible. This plane is more difficult to find and follow than the easy-to-dissect plane usually located between the media and the adventitia, because the plaque invades the media and so the dividing plane is located within the media. In this prospective observational study, CEA was performed in 22 patients to histologically examine the excised plaques and small samples of the whole arterial wall, and evaluate the clinical outcomes. Plaque had invaded the luminal part of the media in the whole arterial wall sample of 80% of cases. Thin medial layers covering > 80% of the surface of the plaque were found in 16 of 22 plaques (73%). Some atheromatous component was sometimes left in the preserved media, rather than completely removed with the media. No morbidity or mortality had occurred by discharge. Only 1 small ipsilateral infarction (4.5%) and no restenosis of greater than 50% were detected during the mean follow-up period of 7 years. Since the plaque usually invades the media, the optimum dissection plane may be located within the media, dividing it into two layers. The presence of some remnant atheromatous components in the preserved media was not associated with surgical complications or restenosis.

Single-cell profiling reveals inflammatory polarization of human carotid versus femoral plaque leukocytes

“…The pathologist screened whole H&E-stained slides cut from these formalin-fixed, paraffin embedded blocks of atheroma from 42 additional patients who underwent carotid or femoral endarterectomy, for the purpose of determining whether 5 or more cells with lymphoid appearance were present in any high-powered field; 12 of 42 samples (7 carotid, 5 femoral) met these criteria. Notably, none of the 42 samples contained adventitial tissue per the reviewing pathologist, consistent with endarterectomy technique of avoiding adventitial tissue (102). Contiguous slides from the same blocks of these 12 plaque samples subsequently underwent IHC.…”

Histopathological Examination of a Symptomatic Carotid Web: A Case Report

“…Histopathological examinations are crucial not only to diagnostic purposes but also to understand better this disease's pathophysiology. 21,22) Accumulating precise histological analyses of CEA specimens containing CaWs is essen-NMC Case Report Journal Vol. 11, 2024 tial to clarify the pathogenesis and prognosis of CaWs.…”

Extracellular Matrix Patches for Endarterectomy Repair

“…Endarterectomy is a recommended approach to the management of significant atherosclerotic stenosis of the femoral or carotid arteries. In a surgical endarterectomy, an arteriotomy is performed and a cleavage plane is developed within the arterial wall between the intima and the media to remove the pathologic intima and to increase the luminal area of the artery (4). In some cases, the media may also be partially or completely removed during stripping of the atheroma, leaving the treated vessel without the smooth intimal lining and, possibly, portions of the muscular media (4)(5)(6).…”