Strategy for a Safe Carotid Endarterectomy Operation

Abstract

Carotid endarterectomy (CEA) remains an effective treatment for severe carotid artery stenosis in symptomatic and asymptomatic patients. Therefore, CEA is an essential surgical technique for neurosurgeons to perform. In this study, we describe preoperative and operational maneuvers and techniques for CEA. When done under general anesthesia, neuromonitoring offers better sensitivity for predicting postoperative neurological deficits. Individual surgeons must opt for a selective or routine shunt that they are more comfortable with. The neck is extended and turned away from the side being operated on. Longitudinal or combined skin incisions is common. Most surgeons use a microscope to dissect the artery and plaque. Surgeons cut the ansa cervicalis at the origin to lift the hypoglossal nerve for dissection of the highly positioned plaque. If the occipital artery disturb to secure the distal internal carotid artery (ICA) site, it can be cut. Patch angioplasty reduces the risk of stroke and restenosis compared with primary closure. However, only a few surgeons in Japan perform patch angioplasty; most surgeons encounter only a small volume of CEA cases in Japan. Therefore, training programs and the development of in vivo training models are important.